Prehospital noninvasive ventilation can help in management of patients with limitations of life-sustaining treatments.
OBJECTIVE
To evaluate the possible place of noninvasive positive pressure ventilation (NPPV) as a reversible and adjustable option offering the possibility of sustaining life until the hospital stay for patients with advanced life-support limitations and life-threatening respiratory distress in the prehospital setting.


METHODS
Patients managed by a physician-staffed Emergency Medical Service unit were retrospectively included if they met the three inclusion criteria: a respiratory failure with oxygen saturation (pulse oximetry) less than 90% (or respiratory exhaustion) under oxygen 15 l/min and a do-not-intubate discussion (according to the physician on-scene) and impossibility of conducting the discussion of withholding advanced life support on-scene.


RESULTS
Twelve patients were included. NPPV was a continuous positive airway pressure for eight patients and a bilevel positive airway pressure given by a ventilator for four patients. All the patients improved from respiratory point of view; respiratory rate decreased from 34 + or - 13 to 27 + or - 10 (P = 0.009) and pulse oximetry increased from 86 + or - 5 to 94 + or - 3% (P<0.01). NPPV was stopped in one case because of discomfort and worsening of consciousness, despite improved respiratory status.


CONCLUSIONS
This pilot series is promising and suggests that it could be a good option in case of limitations of life-sustaining treatments in the prehospital setting. A large controlled multicenter study, evaluating the use of NPPV in this context, would be very valuable.
Department of Anaesthesiology and Intensive Care, Beaujon University Hospital, 100 bd du Général Leclerc, Clichy 92110, France. fxduchateau@orange.fr
François-Xavier
FX
Duchateau
Sébastien
S
Beaune
Agnès
A
Ricard-Hibon
Jean
J
Mantz
Philippe
P
Juvin
D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D006801:Humans; D008020:Life Support Care; D010092:Oximetry; D010166:Palliative Care; D010865:Pilot Projects; D011175:Positive-Pressure Respiration; D056152:Respiratory Rate; D012189:Retrospective Studies; D016896:Treatment Outcome