title: Management of critical illness with non-invasive ventilation by an Australian HEMS.
abstract: BACKGROUND
  Non-invasive ventilation (NIV) therapy is widely used for the management of acute respiratory failure. The objective of this study was to investigate the current use of NIV during interhospital retrievals in an Australian physician-led aeromedical service.
  
  
  METHODS
  We reviewed patients receiving NIV during interhospital retrieval at the Greater Sydney Area Helicopter Medical Services (GSA-HEMS) over a 14-month period. The main objectives were to describe the number of retrievals using NIV, the need for intubation in NIV patients and the effect of the therapy on mission duration.
  
  
  RESULTS
  Over the study period, 3018 missions were reported; 106 cases (3.51%) involved administration of NIV therapy during the retrieval. The most common indication for NIV was pneumonia (34.0%). 86/106 patients received a successful trial of NIV therapy prior to interhospital transfer. 58 patients were transferred on NIV, while 28 patients had NIV removed during transport. None of these 86 patients required intubation or died, although 17/86 ultimately required intubation within 24 hours at the receiving centre. 20/106 patients required intubation at the referring hospital after a failed trial of NIV therapy. NIV was successfully used in all available transport platforms including rotary wing. Patients receiving NIV were found to have prolonged mission durations compared with other GSA-HEMS patients (222.5 vs 193 min). This increase in mission duration was largely attributable to NIV failure, resulting in a need for Rapid Sequence Intubation at the referring hospital.
  
  
  CONCLUSIONS
  With careful patient selection, the use of interhospital NIV is feasible and appears to be safe in a retrieval system with care provided by a critical care physician.
authors.affiliation: Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia.|Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Coggins
authors.affiliation: Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Cummins
authors.affiliation: Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia.|Ambulance Service of New South Wales, Greater Sydney Area HEMS, Sydney, New South Wales, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances / Q000592:standards / Q000706:statistics & numerical data; D000401:Aircraft; D001315:Australia; D016638:Critical Illness / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000628:therapy
keywords: emergency care systems, remote and rural medicine; prehospital care, clinical management; ventilation, non invasive