Prehospital CPAP for Acute Respiratory Failure

R. Eleanor Anderson, MD, Calvin A. Brown, III, MD, FAAEM


A systematic review of controlled trials suggests that CPAP reduces need for intubation.


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 reduction in intubation rate in the prehospital CPAP group versus the standard medical treatment group (odds ratio, 0.16) and a reduction in mortality (OR, 0.3). None of the four studies showed differences in length of stay in the hospital or intensive care unit.


This systematic review highlights the dearth of high-quality data on prehospital CPAP and NIV. In one randomized trial, the need for intubation was reduced with CPAP, and although it seems intuitive that earlier intervention with CPAP or NIV in acute respiratory distress should decrease the need for intubation, more data are needed to substantiate this finding before practice recommendations can be made.


Bakke SA et al. Contunious positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure: A systematic review of controlled studies. Scand J Trauma Resusc Emerg Med. 2014 Nov; 22:69. (

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