title: An observational study of noninvasive positive pressure ventilation in an out-of-hospital setting.
abstract: OBJECTIVE
  Out-of-hospital clinical experience with noninvasive bilevel positive airway pressure (BiPAP) ventilation is extremely limited compared to inhospital management. The aims of this study were to assess the feasibility of out-of-hospital BiPAP ventilation in patients with acute respiratory distress of various origins, and to look for specific factors associated with failure of this respiratory support.
  
  
  METHODS
  This 2-year prospective observational study assessed the failure rate of out-of-hospital BiPAP ventilation, the difficulties encountered, and factors predictive of failure by multivariate analysis.
  
  
  RESULTS
  Overall, 138 patients were treated by out-of-hospital BiPAP for congestive heart failure (56%), chronic obstructive pulmonary disease exacerbation (28%), and acute respiratory failure (16%). Failure rate was 26% (35/138; 95% confidence interval, 18%-33%) (11 before and 24 after reaching hospital). Independent risk factors were the cause of respiratory distress (chronic obstructive pulmonary disease exacerbation; acute respiratory failure) and an audible air leakage.
  
  
  CONCLUSIONS
  The failure rate of BiPAP initiated out-of-hospital was no different from previous reports for inhospital failure rates. Failure was attributable to similar causes.
authors.affiliation: SAMU 94, CHU H Mondor (AP-HP), 94000 Créteil, France.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Bruge
authors.forename: Patricia
authors.initials: P
authors.lastname: Jabre
authors.forename: Michel
authors.initials: M
authors.lastname: Dru
authors.forename: Chadi
authors.initials: C
authors.lastname: Jbeili
authors.forename: Eric
authors.initials: E
authors.lastname: Lecarpentier
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khalid
authors.forename: Alain
authors.initials: A
authors.lastname: Margenet
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
authors.forename: Xavier
authors.initials: X
authors.lastname: Combes
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D017211:Treatment Failure