![]() Original research studies of CPAP in Nordic EMS systems are sparse in a Finnish observational study from 2003, use of prehospital CPAP administered by physicians to patients with presumed acute severe pulmonary oedema improved oxygen saturation, respiratory rate, heart rate and systolic blood pressure. There have been conflicting results in recent systematic reviews including both randomised and observational studies regarding the effectiveness of prehospital CPAP on mortality in patients with acute respiratory failure. In three of four randomised controlled trials in prehospital settings, standard care plus CPAP reduced intubation rate compared to standard care alone. In previous studies of patients treated with CPAP in the prehospital setting, reporting of adverse events have included either none at all, mask intolerance or minor complications such as hypotension, nausea or vomiting. ![]() CPAP is administered to patients with spontaneous breathing through a non-invasive facemask with a positive airway pressure applied during the entire respiratory cycle and it has been shown that prehospital CPAP reduces dyspnoea and respiratory rate when compared to standard medical therapy alone. To prevent situations of such deterioration, prehospital initiation of continuous positive airway pressure (CPAP) has become available. Patients with acute respiratory failure have a risk of further deterioration during transport to hospital by emergency medical services (EMS). Non-invasive positive pressure ventilation administered in hospital reduces mortality in patients suffering from acute cardiopulmonary oedema or acute exacerbations of chronic obstructive pulmonary disease, while its effect in patients with acute exacerbations of asthma is uncertain. Common causes of non-traumatic breathing difficulties include acute cardiopulmonary oedema, lower respiratory tract infections and acute exacerbation of chronic obstructive pulmonary disease (COPD) or asthma, which in severe cases may require non-invasive positive pressure ventilation or endotracheal intubation and mechanical ventilation. ![]() Acute respiratory failure is one of the major causes of emergency department admission as reflected by the fact that 7.3 % of calls to the Danish emergency medical communication centres (EMCCs) have “difficulty in breathing” as the main symptom.
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