Prehospital management begins with stabilization of the patient’s airway and breathing. The initial rapid assessment should involve measurement of oxygen saturation and application of supplemental oxygen as needed. Patients with acute decompensation without contraindications often respond well to noninvasive positive pressure ventilation (NIPPV) en route to the hospital. Early application of this therapy by paramedics can prevent clinical deterioration and helps to avoid intubation. A meta-analysis involving 5 studies and 1002 patients demonstrated a reduction in both intubations and mortality with the use of continuous positive airway pressure (CPAP) in prehospital patients with acute respiratory failure.12
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