Prehospital CPAP for Acute Respiratory Failure

Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are commonly used in-hospital therapies for respiratory failure, predominantly in patients with chronic obstructive pulmonary disease and pulmonary edema. To examine whether use of CPAP or NIV in the prehospital setting reduces mortality, length of stay, or need for intubation, researchers conducted a systematic review of controlled trials.

Of 12 studies that met inclusion criteria, only four — all pertaining to CPAP — had acceptable power and risk of bias. Of these four studies, two included patients with acute respiratory distress of any etiology, and two included patients with acute pulmonary edema. One small, randomized, controlled trial (69 patients) showed a r…