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Analysis of Management of Noninvasive Ventilation Support in Prehospital Care for COPD Patients and Short-term Outcome FREE TO VIEW

Jerome Cuny, MD; Guilaume Campagne, MD; Patrick Goldstein, MD; Nathalie Assez, MD; Eric Wiel, PhD
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University Hospital of Lille, Lille, France

Chest. 2013;144(4_MeetingAbstracts):888A. doi:10.1378/chest.1670611
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SESSION TITLE: Respiratory Support Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Benefits of the use of NIV in the emergency department are well established. Training and available staff, choice of respiratory machines are essential criteria for success. Purpose is to know is there are benefits to use NIV support in pre-hospital care.

METHODS: We've conducted an observational, descriptive, retrospective, single-center study, in a 4 months period. COPD patients with respiratory failure who received prehospital NIV were included. We've compared two groups: COPD patients with NIV, and COPD patients without NIV.

RESULTS: 42 patients were included, mean age 68.86 years old (± 11.98), 57.14% smokers , 64.28% arterial Hypertension, 100% long-term oxygenotherapy, 23.80% antibiotics in the 7 days before, 28.57% corticosteroids. 88.09% had bronchospasm, 78.26% had struggle signs, 28.57% were unable to speak, 14.28% of patients were sweating. Mean respiratory rate was 30.5 cycles/min (± 7.17), mean pulse rate was 105.76 (± 25.34). Nasal EtCO2 47.75 mmHg (± 16.53), pulse oxymetry in air was 85% (± 10.94), oxygen flow rate was 5.45 l / min (± 2.42), temperature was 37.14 (± 8.15). 20 patients received NIV. 61.90% were admitted in Emergency department, 35.71% in ICU, 1 patient was left at home. 1 patient was intubated in the hosting service. Died rate in the 1 month is 13.04%. A significant difference (p<0.05) were found for: sweats (30% / 0), Respiratory Rate (34 ± 8.23/27 ± 6.11), nasal EtCO2 (55.0 ± 24.4 / 40.50 ± 9.03), pulse oxymetry in air (80% ± 8.63% ± 13.25/90), pulse oxymetry with oxygen (89.4% ± 4.24/87.90 ± 2.55), beta2-mimetic and anti cholinergic nebulization (60% ± 0.5/90 ± 0.29%), Emergency room admission (35% ± 0.35% ± 0.48/86),ICU admission (60% ± 0.5/13 ± 0.35%), arterial blood gases on arrival in the host service (PaCO2 76.6 ± 18.66 / 43.93 ± 11.78). No difference for died rater at 1 month (2/3).

CONCLUSIONS: Non-Invasive Ventilation has improved the management and prognosis of COPD patients admitted in emergency room. Very few studies concerning the pre-hospital management. NIV seems to show an interest on pre-hospital care, especially in patients with signs of severity, hypercapnia, without fever. Oxygenation and hypercapnia seem to be improve. Also less patients are admitted in ICU. Bronchospasm don't seem to be an obstacle.

CLINICAL IMPLICATIONS: Schmidbauer W, Ahlers O, Spies C, Dreyer A, Mager G, Kerner T. Early prehospital use of NIV improves acute respiratory failure in acute exacerbation of COPD. Emerg Med J. 2011 Jul;28(7):626-7

DISCLOSURE: The following authors have nothing to disclose: Jerome Cuny, Guilaume Campagne, Patrick Goldstein, Nathalie Assez, Eric Wiel

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