title: Prehospital CPAP Therapy by Emergency Physicians in Patients with Acute Respiratory Failure due to Acute Cardiogenic Pulmonary Edema or Acutely Exacerbated COPD.
abstract: BACKGROUND
  Acute respiratory failure is a frequent cause of emergency medical missions. Continuous positive airway pressure (CPAP) therapy could be particularly beneficial, avoiding risks associated with intubation and invasive ventilation. Hardly any data exist from Germany on this matter.
  
  
  METHODS
  CPAP therapy with the Boussignac system as additional measure was introduced in cases of acute cardiogenic pulmonary edema (ACPE) or decompensated chronic obstructive pulmonary disease (COPD) in a physician-supported emergency medical services system (EMS).
  
  
  RESULTS
  A total of 57 patients, 35 with ACPE and 22 with COPD, received CPAP. Oxygen saturation improved from 81.6% to 94.8%, and respiration rate from 26.9/min to 18.9/min (p<0.001). Seven patients (12.2%) needed secondary intubation [COPD: one patient; ACPE: six patients, including three with acute coronary syndrome (ACS)].
  
  
  CONCLUSIONS
  In physician-supported EMS, CPAP using the Boussignac system is an effective additional measure for ACPE or COPD. For causal ACS, the risk of therapy failure increases.
authors.affiliation: Clinic for Anaesthesiology, Intensive Care and Emergency Medicine I, Westpfalz Hospital, Kaiserslautern, Germany tluiz@westpfalz-klinikum.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Luiz
authors.affiliation: Clinic for Anaesthesiology, Intensive Care and Emergency Medicine I, Westpfalz Hospital, Kaiserslautern, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Kumpch
authors.affiliation: Emergency Department, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Grüttner
authors.affiliation: Clinic for Anaesthesiology, Intensive Care and Emergency Medicine I, Westpfalz Hospital, Kaiserslautern, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Madler
authors.affiliation: Clinic for Anaesthesiology and Operative Intensive Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Viergutz
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D045422:Continuous Positive Airway Pressure / Q000379:methods; D018450:Disease Progression; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D011654:Pulmonary Edema / Q000150:complications*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Boussignac; COPD; CPAP; Continuous positive airway pressure; cardiogenic pulmonary edema; chronic obstructive pulmonary disease; emergency medical services