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Non-Invasive Ventilation in the Prehospital Emergency Setting: A Systematic Review and Meta-Analysis.
Scquizzato, Tommaso; Imbriaco, Guglielmo; Moro, Federico; Losiggio, Rosario; Cabrini, Luca; Consolo, Filippo; Landoni, Giovanni; Zangrillo, Alberto.
Afiliação
  • Scquizzato T; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Imbriaco G; Centrale Operativa 118 Emilia Est, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
  • Moro F; Critical Care Nursing Master Course, University of Bologna, Bologna, Italy.
  • Losiggio R; Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy.
  • Cabrini L; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Consolo F; Department of Biology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
  • Landoni G; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Zangrillo A; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Prehosp Emerg Care ; 27(5): 566-574, 2023.
Article em En | MEDLINE | ID: mdl-35695184
ABSTRACT

INTRODUCTION:

Noninvasive ventilation is a well-established treatment for acute respiratory failure, being increasingly applied in the prehospital setting. This systematic review and meta-analysis aims to investigate whether early prehospital initiation of noninvasive ventilation reduces mortality compared to standard oxygen therapy.

METHODS:

We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to February 7th, 2022, for studies comparing prehospital noninvasive ventilation performed by emergency medical services versus standard oxygen therapy in patients with acute respiratory failure. The primary outcome was mortality at the longest follow-up available.

RESULTS:

We included ten randomized studies and two quasi-randomized studies for a total of 1485 patients. Prehospital treatment with noninvasive ventilation compared with standard oxygen therapy did not significantly reduce mortality at the longest follow-up available (107/810 [13%] vs 114/772 [15%]; RR = 0.89; 95% CI, 0.70-1.13; P = 0.34; I2=24%). The endotracheal intubation rate was reduced when receiving prehospital noninvasive ventilation (38/776 [4.9%] vs 81/743 [11%]; RR = 0.44; 95% CI, 0.31-0.63; P < 0.001; I2=0%; number needed to treat 17). The intensive care admission rate (114/532 [21%] vs 129/507 [25%]; RR = 0.85; 95% CI, 0.69-1.04; P = 0.11; I2=0%) and length of hospital stay (mean difference=-1.29 days; 95% CI, -3.35-0.77; P = 0.21; I2=82%) were similar between groups.

CONCLUSIONS:

Adults with acute respiratory failure treated in the prehospital setting with noninvasive ventilation had a lower risk of intubation than those managed with standard oxygen therapy, with similar risk of death, intensive care admission, and length of hospital stay. REVIEW REGISTRATION PROSPERO CRD42021284947.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Insuficiência Respiratória / Serviços Médicos de Emergência / Ventilação não Invasiva Tipo de estudo: Clinical_trials / Systematic_reviews Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Insuficiência Respiratória / Serviços Médicos de Emergência / Ventilação não Invasiva Tipo de estudo: Clinical_trials / Systematic_reviews Limite: Adult / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article