title: Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure.
abstract: BACKGROUND
  Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by nurses and not physicians. It was hypothesised that ambulance nurses are able to identify patients with ACPE and can successfully apply BCPAP. A prospective case series of patients with presumed ACPE treated with BCPAP by ambulance nurses is described.
  
  
  METHODS
  After training of ambulance nurses, all 33 ambulances in the region were equipped with BCPAP. ACPE was diagnosed on clinical signs and pulse oximetry saturation (Spo(2)) <95%. BCPAP (5 cm H(2)O, Fio(2)>80%) was generated with an oxygen flow of 15 l/min. The physiological responses, experiences and clinical outcomes of the patients were collected from ambulance and hospital records, and ambulance nurses and patients received a questionnaire.
  
  
  RESULTS
  From March to December 2006, 32 patients (age range 61-94 years) received BCPAP during transport to six different regional hospitals. In 26 patients (81%) a diagnosis of ACPE was confirmed. With BCPAP, median (IQR) Spo(2) increased from 79% (69-94%) to 96% (89-98%) within 20 min. The median (IQR) duration of BCPAP treatment was 26 min (21-32). The patients had no negative recollections of the treatment. Ambulance personnel were satisfied with the BCPAP therapy.
  
  
  CONCLUSIONS
  When applied by ambulance nurses, BCPAP was feasible and effective in improving oxygen saturation in patients with ACPE. Although survival benefit can only be demonstrated by further research, it is considered that BCPAP can be implemented in all ambulances in the Netherlands.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. w.dieperink@chir.umcg.nl
authors.forename: W
authors.initials: W
authors.lastname: Dieperink
authors.forename: E E M
authors.initials: EE
authors.lastname: Weelink
authors.forename: I C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: R
authors.initials: R
authors.lastname: de Vos
authors.forename: T
authors.initials: T
authors.lastname: Jaarsma
authors.forename: L P H J
authors.initials: LP
authors.lastname: Aarts
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
authors.forename: M W N
authors.initials: MW
authors.lastname: Nijsten
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D016529:Emergency Nursing; D004638:Emergency Treatment / Q000451:nursing*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000401:mortality / Q000451:nursing*; D016896:Treatment Outcome