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Artículo CPAP en atención Prehospitalaria

publicado a la‎(s)‎ 26 ago. 2011 9:50 por Juan Manuel Fraga Sastrías   [ actualizado el 30 ago. 2011 9:02 ]
Se anexa artículo y preguntas al final.

Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial.



Annals of Emergency Medicine - Volume 52, Issue 3 (September 2008) (MEDLINE® is the source for the citation and abstract of this record)  -  About This Journal  DOI: 10.1016/j.annemergmed.2008.01.006


Abstract:

STUDY OBJECTIVE: Continuous positive airway pressure ventilation (CPAP) in appropriately selected patients with acute respiratory failure has been shown to reduce the need for tracheal intubation in hospital. Despite several case series, the effectiveness of out-of-hospital CPAP has not been rigorously studied. We performed a prospective, randomized, nonblinded, controlled trial to determine whether patients in severe respiratory distress treated with CPAP in the out-of-hospital setting have lower overall tracheal intubation rates than those treated with usual care. METHODS: Out-of-hospital patients in severe respiratory distress, with failing respiratory efforts, were eligible for the study. The study was approved under exception to informed consent guidelines. Patients were randomized to receive either usual care, including conventional medications plus oxygen by facemask, bag-valve-mask ventilation, or tracheal intubation, or conventional medications plus out-of-hospital CPAP. The primary outcome was need for tracheal intubation during the out-of-hospital/hospital episode of care. Mortality and length of stay were secondary outcomes of interest. RESULTS: In total, 71 patients were enrolled into the study, with 1 patient in each group lost to follow-up after refusing full consent. There were no important differences in baseline physiologic parameters, out-of-hospital scene times, or emergency department diagnosis between groups. In the usual care group, 17 of 34 (50%) patients were intubated versus 7 of 35 (20%) in the CPAP group (unadjusted odds ratio [OR] 0.25; 95% confidence interval [CI] 0.09 to 0.73; adjusted OR 0.16; 95% CI 0.04 to 0.7; number needed to treat 3; 95% CI 2 to 12). Mortality was 12 of 34 (35.3%) in the usual care versus 5 of 35 (14.3%) in the CPAP group (unadjusted OR 0.3; 95% CI 0.09 to 0.99). CONCLUSION: Paramedics can be trained to use CPAP for patients in severe respiratory failure. There was an absolute reduction in tracheal intubation rate of 30% and an absolute reduction in mortality of 21% in appropriately selected out-of-hospital patients who received CPAP instead of usual care. Larger, multicenter studies are recommended to confirm this observed benefit seen in this relatively small trial.

Citation:

Out-of-hospital continuous positive airway pressure ventilation versus usual care in acute respiratory failure: a randomized controlled trial.
Thompson J - Ann Emerg Med - 01-SEP-2008; 52(3): 232-41, 241.e1
MEDLINE® is the source for the citation and abstract of this record

NLM Citation ID:
18387700 (PubMed ID)

Comment:

  • Ann Emerg Med. 2008 Sep;52(3):242-3
    PubMed ID: 18722248

Full Source Title:
Annals of emergency medicine

Publication Type:
Journal Article; Multicenter Study; Randomized Controlled Trial

Language:
English

Author Affiliation:
Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.

Authors:
Thompson J; Petrie DA; Ackroyd-Stolarz S; Bardua DJ

Major Subjects:

  • Continuous Positive Airway Pressure
  • Emergency Medical Services / * methods
  • Intubation, Intratracheal
  • Respiratory Insufficiency / mortality / * therapy

Additional Subjects:

  • Female
  • Humans
  • Length of Stay
  • Male

Preguntas

Envía tus respuestas antes del 30 de septiembre a juanmfraga@emergencias.org.mx para que se te otorgue dos puntos de educación contínua en tu expediente.
  1. Existe un riesgo más elevado de broncoaspiración y falla en la intubación de los pacientes que no están en paro cardiaco cuando se intentan intubar fuera del hospital en comparación con la sala de Emergencia.   Verdadero o Falso.
  2. ¿Que tipo de diseño tiene este estudio?
  3. ¿Cuales fueron los criterios de inclusión para que los pacientes fueran incluidos en este estudio?
  4. ¿Cuales fueron los criterios de exclusión?
  5. ¿Cual fue el diagnóstico más frecuente entre los pacientes con dificultad respiratoria tratados en este estudio?
  6. De acuerdo a este estudio que favorece mejor la supervivencia de los pacientes con dificultad respiratoria ¿el manejo usual o el uso de CPAP?
  7. ¿Se puede generalizar esta experiencia y generar una recomendación a partir de este artículo? ¿Porque?



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