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.
Duchateau
François-Xavier
FX
Department of Anaesthesiology and Intensive Care, Beaujon University Hospital, 100 bd du Général Leclerc, Clichy 92110, France. fxduchateau@orange.fr
Beaune
Sébastien
S
Ricard-Hibon
Agnès
A
Mantz
Jean
J
Juvin
Philippe
P
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