title: [Prehospital non-invasive ventilation in Germany: results of a nationwide survey of ground-based emergency medical services].
abstract: OBJECTIVE
  Non-invasive ventilation (NIV) is an evidence-based treatment of acute respiratory failure and can be helpful to reduce morbidity and mortality. In Germany national S3 guidelines for inhospital use of NIV based on a large number of clinical trials were published in 2008; however, only limited data for prehospital non-invasive ventilation (pNIV) and hence no recommendations for prehospital use exist so far.
  
  
  OBJECTIVE
  In order to create a database for pNIV in Germany a nationwide survey was conducted to explore the status quo for the years 2005-2008 and to survey expected future developments including disposability, acceptance and frequency of pNIV.
  
  
  METHODS
  A questionnaire on the use of pNIV was developed and distributed to 270 heads of medical emergency services in Germany.
  
  
  RESULTS
  Of the 270 questionnaires distributed 142 could be evaluated (52 %). The pNIV was rated as a reasonable treatment option in 91 % of the respondents but was available in only 54 out of the 142 responding emergency medical services (38 %). Continuous positive airway pressure (98 %) and biphasic positive airway pressure (22 %) were the predominantly used ventilation modes. Indications for pNIV use were acute cardiogenic pulmonary edema (96 %), acute exacerbation of chronic obstructive pulmonary disease (89 %), asthma (32 %) and pneumonia (28 %). Adverse events were reported for panic (20 ±  17%) and non-threatening heart rhythm disorders (8 ± 5%), the rate of secondary intubation was low (reduction from 20 % to 10 %) and comparable to data from inhospital treatment.
  
  
  CONCLUSIONS
  Prehospital NIV in Germany was used by only one third of all respondents by the end of 2008. Based on the clinical data a growing application for pNIV is expected. Controlled prehospital studies are needed to enunciate evidence-based recommendations for pNIV.
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland, timursellmann@yahoo.com.
authors.forename: T
authors.initials: T
authors.lastname: Sellmann
authors.forename: C
authors.initials: C
authors.lastname: Conty
authors.forename: T
authors.initials: T
authors.lastname: Treschan
authors.forename: D
authors.initials: D
authors.lastname: Kindgen-Milles
mesh_terms: D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000191:economics / Q000379:methods*; D004636:Emergency Service, Hospital; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D063087:Noninvasive Ventilation / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D011654:Pulmonary Edema / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy; D011795:Surveys and Questionnaires