I just wanted to note some of the more recent developments in Pre-Hospital CPAP. I have heard numerous anecdotal references about the utility of CPAP on COPD. Several times, I have heard from clinicians who extol the virtues of combining low pressure CPAP with a nebulizer treatment.
I like the Emergent PortO2Vent CPAP device. I explained why on an earlier post
. It is about the easiest one to use a nebulizer with. You can easily put an albuterol treatment in front of the patient valve at the mask. The PortO2Vent is not dependent on an external PEEP valve. The PEEP is incrementally adjustable with a single knob, and it has a pressure gauge so you can see what you are really doing. These features combined permit gradual titration to clinical effect, like about everything else we do.
Let me share an example of this type application. Have you ever had an experience like this? COPD Patient has been home gradually getting worse for several days, and says their puffer just is not working for them. That is why they called an ambulance. Typically, this patient requires numerous serial breathing treatments. Some wind up getting worse and even intubated and mechanically ventilated.
Try starting CPAP at 2-5cm (low) PEEP with high FIO2 and an in line nebulizer treatment. Gradually increase the PEEP pressure to patient tolerance. Because the PEEP holds the proximal airways open & positive inspiratory pressures drive the bronchodilator treatment down – more of the nebulized drug is delivered to therapeutic effect. The patient often gets better rapidly, and does not need to be intubated or even admitted.
Well, finally there is a real good pre-hospital CPAP study with over 300 patients enrolled that proves this treatment is effective. The patients enrolled had various conditions which caused acute respiratory distress. It looked at how many patients were intubated up to 12 hours after hospital arrival. This makes a lot of sense. It would not be all that great if the CHF patients treated with CPAP, just got intubated later anyway.
The documented results were conclusive; CPAP works, and for much more than just CHF. I have an advance copy of this abstract. It’s pretty interesting. If anyone wants a copy, drop me an e-mail & I’ll reply with the abstract attached.
We have also heard more about CPAP for Flail Chest (click HERE and HERE) and Applications for Drowning Victims (click HERE and HERE). As I learn more about the utility of CPAP in EMS, I am surprised at its versatility. But it only makes good sense. CPAP helps a breathing patient breath better. We breath for people when they can’t breath on their own, why not try helping them out before they stop?