Helseeffekt og kostnadseffektivitet av prehospital Continuous Positive Airway Pressure (CPAP) et litteraturstudium

Abstract

Background: Respiratory failure is a common problem in both inhospital and prehospital settings. Continuous positive airway pressure (CPAP) is frequently used inhospitally for treating respiratory failure. The use of CPAP outside of hospitals is increasing although previous summaries of its effect have been somewhat inconclusive. The objective of this thesis is to summarize available research and assess the effectiveness and cost-effectiveness of prehospital use of CPAP as an addition to standard therapy. Method: A literature search was performed in Ovid MEDLINE. Inclusion criteria were any studies that compared prehospital CPAP with standard treatment in the prehospital setting. 177 articles were identified and screened by hand, first by title and/or abstract. 68 full-text articles were subsequently screened by hand. Excluded articles included guidelines, case-studies, qualitative studies, studies that used bilevel positive airway pressure (BPAP) instead of CPAP, studies that lacked a control group and three articles which were either not found in full-text or not found in English or a Nordic language. Results: A total of twenty articles were included. The articles included seven reviews, two economic models, three randomized controlled studies (RCTs), one quasi-RCT and seven observational studies. Four of the reviews contained a meta-analysis and one contained an economic model. All four meta-analyses presented significant findings in favor of prehospital use of CPAP considering short-term (within 30 days or discharge) mortality and risk of intubation. Effects on other outcomes such as change in vital measurements, hospital- and intensive care length of stay were inconclusive due to lack of data. The included single studies varied in many ways, such as which patients were included, how they were treated and by whom. The results varied as well, but in total seemed promising with respect to prehospital CPAP use. Four single studies found a decline in mortality, two studies found a decline in intubation rates, four studies found a significant difference in improving vital measurements and clinical scores, and one study found a significant decline in hospital length of stay. Cost-effectiveness was difficult to ascertain from the articles included, but cost-effectiveness seemed to be possible to reach with large enough patient populations. Conclusion: CPAP seems to be an effective additional treatment for prehospital patients with respiratory failure. The costs should be calculated before implementing the treatment.