Clinical factors associated with the use of NIV in the pre-hospital setting in adult patients treated for acute COPD exacerbation : a single-center retrospective cohort study

Article Article scientifique Article Clinical factors associated with the use of NIV in the pre-hospital setting in adult patients treated for acute COPD exacerbation : a single-center retrospective cohort study eng 2025-02-27 author Von Düring Stephan 0000-0001-7774-5690 Division of Intensive Care Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland. Stephan.vonDuring@hug.ch.,Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. Stephan.vonDuring@hug.ch. 584286 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) Stephan von Düring author Chevalley Benjamin Division of Anaesthesiology, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland. 729862 author Wozniak Hannah 0000-0001-5404-4621 Division of Intensive Care Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 698325 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Desmettre Thibaut 0000-0003-4585-5494 Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 412936 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Quintard Hervé 0000-0002-3870-6370 Division of Intensive Care Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 951770 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Suppan Laurent 0000-0001-6989-6421 Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland. 505697 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Fehlmann Christophe 0000-0002-4163-0338 Division of Emergency Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland. 633754 32 10.1186/s12873-025-01193-0 40016646 1471-227X PMC11869654 https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-025-01193-0 Background: Non-invasive ventilation (NIV) is a cornerstone in the management of acute chronic obstructive pulmonary disease (COPD) exacerbations with respiratory failure. While extensively studied in hospital settings, limited data exist on its use in the pre-hospital setting and clinical factors influencing its application. This study aimed to identify predictors of NIV use in the pre-hospital setting and to assess its association with patient-centered outcomes. Methods: This single-center retrospective cohort study analyzed data from a pre-hospital emergency medical service registry in Geneva, Switzerland. Adult patients with a presumptive diagnosis of acute COPD exacerbation were included, spanning a control period (2007-2010, before NIV implementation) and an intervention period (2013-2017, after NIV implementation). For the primary analysis, multivariable logistic regression was used to identify predictors of NIV use during the intervention period. For the secondary analysis, coarsened exact matching balanced patients treated with NIV during the intervention period with those from the control period, followed by conditional regression analyses to assess patient-centered outcomes. Results: Among 270 included patients, 84 (46%) received NIV during the intervention period. Age ≥ 70 years (aOR 2.49, 95% CI 1.11, 5.76), female sex (aOR 2.48, 95% CI 1.13, 5.60), and systolic blood pressure (SBP) ≥ 140 mmHg (aOR 2.75, 95% CI 1.19, 6.62) were independent predictors associated with receiving NIV in the pre-hospital setting. In the matched cohort, pre-hospital NIV use was significantly associated with increased ICU admission rates, but was not associated with transport time, emergency department length of stay, hospital length of stay, or 28-day mortality. Sensitivity analyses demonstrated consistent results across different modeling approaches. Conclusions: Age ≥ 70 years, female sex, and SBP ≥ 140 mmHg were independent predictors associated with receiving NIV in the pre-hospital management of acute COPD exacerbation. The association between NIV use and increased ICU admissions may reflect its application in more severely ill patients. Pre-hospital NIV was not associated with short- or long-term outcomes beyond ICU admission. These findings underscore the need for prospective studies to clarify the role of pre-hospital NIV in patient outcomes. Acute disease Chronic obstructive Emergency medical services Noninvasive Prehospital care Pulmonary disease Respiratory insufficiency Ventilation Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false BMC emergency medicine 25 1 352ae714-4a23-4c55-b29c-e02759d11ffb Article (Published version) Public Article_scientifique_from_crossref.pdf 1419287 application/pdf CC BY-NC-ND-4.0 ba2a24ca661c423724dd520b4d89b961c74b093ea312503226f3907e177b60d6 24c91958-2182-4cf2-81fe-a38715a20db2 Supplemental data Public 12873_2025_1193_MOESM1_ESM.pdf 893903 application/pdf ef954a464210bbdcf6bdc8c276bcbdaa6bf196f3b59ca7b344982f82070beba1 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

Title	Published in	Access level	OA Policy	Year	Views	Downloads

Clinical factors associated with the use of NIV in the pre-hospital setting in adult patients treated for acute COPD exacerbation : a single-center retrospective cohort study	BMC emergency medicine			2025	94	272

Archive ouverte UNIGE

Chevalley, Benjamin