human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To describe the prehospital use of a continuous positive airway pressure ( CPAP ) system for the treatment of acute respiratory failure presumed to be due to cardiogenic pulmonary edema . METHODS Prospect i ve case-series analysis . Paramedics administered CPAP via face mask at 10 cm H2O to patients believed to be in cardiogenic pulmonary edema and in imminent need of endotracheal intubation ( ETI ) . Data from run sheets and hospital records were analyzed for treatment intervals , vital signs , complications , admitting diagnoses , need for ETI , and mortality . RESULTS Nineteen patients received prehospital CPAP therapy .  Mean duration of therapy was 15.5 minutes . Pre- and post-therapy pulse oximetry  was available for 15 patients and demonstrated an increase from a mean of 83.3 % to a mean of 95.4 % . None of the patients were intubated in the field . Two patients who did not tolerate the CPAP mask required ETI upon arrival in the emergency department ( ED ) ; an additional five patients required ETI within 24 hours . There was one death in the series and two additional adverse events ( one aspiration pneumonia , one pneumothorax ) ; none of these were attributable to the use of CPAP . The diagnosis of cardiogenic pulmonary edema was corroborated by the ED or in-hospital physician in 13 patients ( 68 % ) . Paramedics reported no technical difficulties with the CPAP system . CONCLUSION For patients with acute respiratory failure and presumed pulmonary edema , the prehospital use of CPAP is feasible and may avert the need for ETI . Future controlled studies are needed to assess the utility and cost-effectiveness of prehospital CPAP systems Objective To compare the physiological effects and the clinical efficacy of continuous positive airway pressure ( CPAP ) vs st and ard medical treatment in elderly patients ( ≥75 years ) with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema . Design A prospect i ve , r and omized , concealed , and unblinded study of 89 consecutive patients who were admitted to the emergency departments of one general , and three teaching , hospitals . Intervention Patients were r and omly assigned to receive st and ard medical treatment alone ( n=46 ) or st and ard medical treatment plus CPAP ( n=43 ) . Measurements Improvement in PaO2/FIO2 ratio , complications , length of hospital stay , early 48-h and overall mortality , compared between the CPAP and st and ard treatment groups . Results Study groups were comparable with regard to baseline physiological and clinical characteristics ( age , sex ratio , autonomy , medical history , cause of pulmonary edema ) . Within 1 h , noninvasive continuous positive airway pressure led to decreased respiratory rate ( respiratory rate , 27±7 vs 35±6 breaths/min ; p=0.009 ) , and improved oxygenation ( PaO2/FIO2 , 306±104 vs 157±71 ; p=0.004 ) compared with baseline , whereas no differences were observed within the st and ard treatment group . Severe complications occurred in 17 patients in the st and ard treatment group , vs 4 patients in the noninvasive continuous positive airway pressure group ( p=0.002 ) . Early 48-h mortality was 7 % in the noninvasive continuous positive airway pressure group , compared with 24 % in the st and ard treatment group ( p=0.017 ) ; however , no sustained benefits were observed during the overall hospital stay . Conclusion Noninvasive continuous positive airway pressure promotes early clinical improvement in elderly patients attending emergency departments for a severe pulmonary edema , but only reduces early 48-h mortality OBJECTIVE To evaluate the utility of bilevel positive airway pressure ( BiPAP ) in the out-of-hospital treatment of patients with presumed congestive heart failure ( CHF ) . METHODS This was a prospect i ve , sequential , parallel trial in an urban setting served by a single emergency medical services ( EMS ) system between January 4 and April 15 , 1999 . A convenience sampling of adults who were transported by rescue units judged to be in CHF by treating emergency medical technicians trained in advanced life support ( ALS EMTs ) was included . Rescue squads were divided into demographically matched pairs , and one of each was equipped with a BiPAP ventilatory support unit . Bilevel positive airway pressure therapy was added to the existing treatment protocol s for eligible study patients . Main outcome measures were out-of-hospital treatment time , oxygen saturation changes , hospitalization length , need for endotracheal intubation , mortality rate , and ease of use of the device by EMS personnel . RESULTS Sixty-two of 71 enrolled patients completed the study .  Out-of-hospital treatment times did not differ between groups ( 31.2 minutes vs 31.4 minutes ; p = 0.931 ) . The difference between pre- and post-treatment oxygen saturation levels was greater for the BiPAP group ( 13.71 % ) than the control group ( 6.69 % ) ( p < 0.05 ) . There was no statistical difference between groups in the length of hospital stay [ control : 7.63 days , vs BiPAP : 6.33 days , p = 0.48 ] , the intubation rate [ control : 7 of 25 ( 28 % ) vs BiPAP : 4 of 37 ( 11 % ) , p = 0.10 ] , or death rate [ control : 2 of 24 , vs BiPAP : 6 of 37 , p = 0.46 ] . All of the ALS EMTs who used BiPAP thought that it was safe to use , and 97 % thought it was easy and appeared to improve patients ' dyspnea and respiratory distress . CONCLUSIONS ALS EMTs can be trained to deliver noninvasive ventilation with BiPAP , find it easy to apply , and believe that it helps relieve dyspnea in patients with suspected CHF Cardiogenic pulmonary edema is a frequent cause of reparatory failure . We investigated the effects of nasal continuous positive airway pressure ( CPAP ) in patients with severe pulmonary edema associated with acute myocardial infa rct ion . Twenty-nine consecutive patients were divided into 3 groups : firstly , 7 intubated patients who received mechanical ventilation at study entry comprised the intubation group . The rest of the patients were r and omly assigned to either of the following 2 groups : 11 patients who received oxygen plus CPAP delivered by a nasal mask ( CPAP group ) , and 11 patients who received oxygen only via face mask ( oxygen group ) . All patients in the intubation group had cardiogenic shock . Two patients ( 18 % ) in the CPAP group and 8 patients ( 73 % ) in the oxygen group required mechanical ventilation with endotracheal intubation ( p=0.03 ) . The hospital mortality rate in the CPAP group ( 9 % ) was significantly lower than the oxygen group ( 64 % , p=0.02 ) . The pulmonary artery wedge pressure and heart rate were significantly lower in the CPAP group than in the oxygen group 24 h after study entry ( p<0.05 and p<0.01 ) . The mean pulmonary artery pressure 48 h after study entry was 18+/-5 mmHg in the CPAP group and 25+/-8 mmHg in the oxygen group ( p<0.05 ) . The PaO2/FiO2 ratio increased in the intubation group ( 168+/-69 to 240+/-57 , p<0.05 ) and the CPAP group ( 137+/-17 to 253+/-67 , p<0.01 ) 24 h after study entry . Arterial plasma endothelin-1 concentrations decreased significantly earlier in the CPAP group than in the oxygen group ( p<0.05 ) . In patients without cardiogenic shock , nasal CPAP lead to an early improvement in oxygenation and hemodynamics , and decreased the mortality rate . Early and active respiratory management is recommended in patients with pulmonary edema associated with acute myocardial infa rct ion Objective Continuous positive airway pressure ( CPAP ) is considered an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema . However , we hypothesized that bilevel noninvasive positive-pressure ventilation ( NPPV ) , which combines both inspiratory pressure support and positive expiratory pressure , would unload the respiratory muscles and improve cardiac and hemodynamic function more effectively than CPAP . Design R and omized crossover study . Setting Critical care unit , Raymond Poincaré Hospital . Patients Six consecutive patients with acute cardiogenic pulmonary edema . Interventions Patients were sequentially treated with 5 cm H2O CPAP , 10 cm H2O CPAP , and NPPV in a r and om order . Measurements and Main Results Cardiac and hemodynamic function and indexes of respiratory mechanics were measured at each treatment sequence . NPPV reduced the esophageal pressure swing and esophageal pressure-time product compared with baseline ( p < .05 ) . There was no reduction in esophageal pressure swing or esophageal pressure-time product with CPAP . NPPV and 10 cm H2O CPAP reduced the mean transmural right and left atrial filling pressures without a change in cardiac index . Conclusions This study demonstrates that NPPV was more effective at unloading the respiratory muscles than CPAP in acute cardiogenic pulmonary edema . In addition , NPPV and 10 cm H2O CPAP produced a reduction in right and left ventricular preload , which suggests an improvement in cardiac performance STUDY OBJECTIVE Noninvasive ventilation has been shown to be effective in patients with acute respiratory failure due to pulmonary edema and exacerbations of COPD . Its role in an acute asthmatic attack , however , is uncertain . The purpose of this pilot study was to compare conventional asthma treatment with nasal bilevel pressure ventilation ( BPV ) [ BiPAP ; Respironics ; Murrysville , PA ] plus conventional treatment in patients with a severe asthmatic attack admitted to the emergency department . DESIGN A prospect i ve , r and omized , placebo-controlled study . SETTING An emergency department at a university hospital . PATIENTS Thirty patients with a severe asthma attack were recruited from a larger group of 124 asthmatic patients seen in the emergency department . Fifteen patients were r and omly assigned to BPV plus conventional therapy and 15 patients to conventional therapy alone . The two groups had similar clinical characteristics on hospital admission . Mean ( + /- SD ) FEV(1 ) on recruitment was 37.3 + /- 10.7 % in the BPV group and 33.8 + /- 10.2 % in the control group ( p = not significant ) . INTERVENTIONS AND MEASUREMENTS BPV with predetermined inspiratory and expiratory pressures was applied for 3 h in the BPV group ; in the control group , a similar sham device with subtherapeutic pressures was applied for 3 h. Bedside lung function test results and vital signs were obtained at baseline , and during and at the completion of the study protocol . RESULTS The use of BPV significantly improved lung function test results . Eighty percents of the patients in the BPV group reached the predetermined primary end points ( an increase of at least 50 % in FEV(1 ) as compared to baseline ) , vs 20 % of control patients ( p < 0.004 ) . Mean rise in FEV(1 ) was 53.5 + /- 23.4 % in the BPV group and 28.5 + /- 22.6 % in the conventional treatment group ( p = 0.006 ) . The intention-to-treat analysis of the secondary end point rate of hospitalization included 33 patients . Hospitalization was required for 3 of 17 patients ( 17.6 % ) in the BPV group , as compared with 10 of 16 patients ( 62.5 % ) in the control group ( p = 0.0134 ) . CONCLUSION In selected patients with a severe asthma attack , the addition of BPV to conventional treatment can improve lung function , alleviate the attack faster , and significantly reduce the need for hospitalization AIMS In acute cardiogenic pulmonary oedema ( ACPE ) , continuous positive airway pressure ( CPAP ) added to medical treatment improves outcome . The present study was design ed to assess the benefit of CPAP as a first line treatment of ACPE in the out-of-hospital environment . METHODS AND RESULTS The protocol lasted 45 min , divided into three periods of 15 min . Patients with ACPE were r and omly assigned in two groups : 1/Early CPAP ( n = 63 ) :  CPAP alone ( T0-T15 ) ; CPAP + medical treatment ( T15-T30 ) ; medical treatment alone ( T30-T45 ) and 2/Late CPAP ( n = 61 ) : medical treatment alone ( T0-T15 ) ; medical treatment + CPAP ( T15-T30 ) ; medical treatment alone ( T30-T45 ) . Primary endpoint : effect of early CPAP on a dyspnoea clinical score and on arterial blood gases . Secondary endpoints : incidence of tracheal intubation , inotropic support , and in-hospital mortality . T0-T15 : CPAP alone had a greater effect than medical treatment on the clinical score ( P = 0.0003 ) and on PaO(2 ) ( P = 0.0003 ) . T15-T30 : adding CPAP to medical treatment ( late CPAP group ) improved clinical score and blood gases and the two groups were no longer different at T30 . T30-T45 : in both groups , CP 
    Output:
    
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***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To describe the prehospital use of a continuous positive airway pressure ( CPAP ) system for the treatment of acute respiratory failure presumed to be due to cardiogenic pulmonary edema . METHODS Prospect i ve case-series analysis . Paramedics administered CPAP via face mask at 10 cm H2O to patients believed to be in cardiogenic pulmonary edema and in imminent need of endotracheal intubation ( ETI ) . Data from run sheets and hospital records were analyzed for treatment intervals , vital signs , complications , admitting diagnoses , need for ETI , and mortality . RESULTS Nineteen patients received prehospital CPAP therapy .  Mean duration of therapy was 15.5 minutes . Pre- and post-therapy pulse oximetry  was available for 15 patients and demonstrated an increase from a mean of 83.3 % to a mean of 95.4 % . None of the patients were intubated in the field . Two patients who did not tolerate the CPAP mask required ETI upon arrival in the emergency department ( ED ) ; an additional five patients required ETI within 24 hours . There was one death in the series and two additional adverse events ( one aspiration pneumonia , one pneumothorax ) ; none of these were attributable to the use of CPAP . The diagnosis of cardiogenic pulmonary edema was corroborated by the ED or in-hospital physician in 13 patients ( 68 % ) . Paramedics reported no technical difficulties with the CPAP system . CONCLUSION For patients with acute respiratory failure and presumed pulmonary edema , the prehospital use of CPAP is feasible and may avert the need for ETI . Future controlled studies are needed to assess the utility and cost-effectiveness of prehospital CPAP systems Objective To compare the physiological effects and the clinical efficacy of continuous positive airway pressure ( CPAP ) vs st and ard medical treatment in elderly patients ( ≥75 years ) with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema . Design A prospect i ve , r and omized , concealed , and unblinded study of 89 consecutive patients who were admitted to the emergency departments of one general , and three teaching , hospitals . Intervention Patients were r and omly assigned to receive st and ard medical treatment alone ( n=46 ) or st and ard medical treatment plus CPAP ( n=43 ) . Measurements Improvement in PaO2/FIO2 ratio , complications , length of hospital stay , early 48-h and overall mortality , compared between the CPAP and st and ard treatment groups . Results Study groups were comparable with regard to baseline physiological and clinical characteristics ( age , sex ratio , autonomy , medical history , cause of pulmonary edema ) . Within 1 h , noninvasive continuous positive airway pressure led to decreased respiratory rate ( respiratory rate , 27±7 vs 35±6 breaths/min ; p=0.009 ) , and improved oxygenation ( PaO2/FIO2 , 306±104 vs 157±71 ; p=0.004 ) compared with baseline , whereas no differences were observed within the st and ard treatment group . Severe complications occurred in 17 patients in the st and ard treatment group , vs 4 patients in the noninvasive continuous positive airway pressure group ( p=0.002 ) . Early 48-h mortality was 7 % in the noninvasive continuous positive airway pressure group , compared with 24 % in the st and ard treatment group ( p=0.017 ) ; however , no sustained benefits were observed during the overall hospital stay . Conclusion Noninvasive continuous positive airway pressure promotes early clinical improvement in elderly patients attending emergency departments for a severe pulmonary edema , but only reduces early 48-h mortality OBJECTIVE To evaluate the utility of bilevel positive airway pressure ( BiPAP ) in the out-of-hospital treatment of patients with presumed congestive heart failure ( CHF ) . METHODS This was a prospect i ve , sequential , parallel trial in an urban setting served by a single emergency medical services ( EMS ) system between January 4 and April 15 , 1999 . A convenience sampling of adults who were transported by rescue units judged to be in CHF by treating emergency medical technicians trained in advanced life support ( ALS EMTs ) was included . Rescue squads were divided into demographically matched pairs , and one of each was equipped with a BiPAP ventilatory support unit . Bilevel positive airway pressure therapy was added to the existing treatment protocol s for eligible study patients . Main outcome measures were out-of-hospital treatment time , oxygen saturation changes , hospitalization length , need for endotracheal intubation , mortality rate , and ease of use of the device by EMS personnel . RESULTS Sixty-two of 71 enrolled patients completed the study .  Out-of-hospital treatment times did not differ between groups ( 31.2 minutes vs 31.4 minutes ; p = 0.931 ) . The difference between pre- and post-treatment oxygen saturation levels was greater for the BiPAP group ( 13.71 % ) than the control group ( 6.69 % ) ( p < 0.05 ) . There was no statistical difference between groups in the length of hospital stay [ control : 7.63 days , vs BiPAP : 6.33 days , p = 0.48 ] , the intubation rate [ control : 7 of 25 ( 28 % ) vs BiPAP : 4 of 37 ( 11 % ) , p = 0.10 ] , or death rate [ control : 2 of 24 , vs BiPAP : 6 of 37 , p = 0.46 ] . All of the ALS EMTs who used BiPAP thought that it was safe to use , and 97 % thought it was easy and appeared to improve patients ' dyspnea and respiratory distress . CONCLUSIONS ALS EMTs can be trained to deliver noninvasive ventilation with BiPAP , find it easy to apply , and believe that it helps relieve dyspnea in patients with suspected CHF Cardiogenic pulmonary edema is a frequent cause of reparatory failure . We investigated the effects of nasal continuous positive airway pressure ( CPAP ) in patients with severe pulmonary edema associated with acute myocardial infa rct ion . Twenty-nine consecutive patients were divided into 3 groups : firstly , 7 intubated patients who received mechanical ventilation at study entry comprised the intubation group . The rest of the patients were r and omly assigned to either of the following 2 groups : 11 patients who received oxygen plus CPAP delivered by a nasal mask ( CPAP group ) , and 11 patients who received oxygen only via face mask ( oxygen group ) . All patients in the intubation group had cardiogenic shock . Two patients ( 18 % ) in the CPAP group and 8 patients ( 73 % ) in the oxygen group required mechanical ventilation with endotracheal intubation ( p=0.03 ) . The hospital mortality rate in the CPAP group ( 9 % ) was significantly lower than the oxygen group ( 64 % , p=0.02 ) . The pulmonary artery wedge pressure and heart rate were significantly lower in the CPAP group than in the oxygen group 24 h after study entry ( p<0.05 and p<0.01 ) . The mean pulmonary artery pressure 48 h after study entry was 18+/-5 mmHg in the CPAP group and 25+/-8 mmHg in the oxygen group ( p<0.05 ) . The PaO2/FiO2 ratio increased in the intubation group ( 168+/-69 to 240+/-57 , p<0.05 ) and the CPAP group ( 137+/-17 to 253+/-67 , p<0.01 ) 24 h after study entry . Arterial plasma endothelin-1 concentrations decreased significantly earlier in the CPAP group than in the oxygen group ( p<0.05 ) . In patients without cardiogenic shock , nasal CPAP lead to an early improvement in oxygenation and hemodynamics , and decreased the mortality rate . Early and active respiratory management is recommended in patients with pulmonary edema associated with acute myocardial infa rct ion Objective Continuous positive airway pressure ( CPAP ) is considered an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema . However , we hypothesized that bilevel noninvasive positive-pressure ventilation ( NPPV ) , which combines both inspiratory pressure support and positive expiratory pressure , would unload the respiratory muscles and improve cardiac and hemodynamic function more effectively than CPAP . Design R and omized crossover study . Setting Critical care unit , Raymond Poincaré Hospital . Patients Six consecutive patients with acute cardiogenic pulmonary edema . Interventions Patients were sequentially treated with 5 cm H2O CPAP , 10 cm H2O CPAP , and NPPV in a r and om order . Measurements and Main Results Cardiac and hemodynamic function and indexes of respiratory mechanics were measured at each treatment sequence . NPPV reduced the esophageal pressure swing and esophageal pressure-time product compared with baseline ( p < .05 ) . There was no reduction in esophageal pressure swing or esophageal pressure-time product with CPAP . NPPV and 10 cm H2O CPAP reduced the mean transmural right and left atrial filling pressures without a change in cardiac index . Conclusions This study demonstrates that NPPV was more effective at unloading the respiratory muscles than CPAP in acute cardiogenic pulmonary edema . In addition , NPPV and 10 cm H2O CPAP produced a reduction in right and left ventricular preload , which suggests an improvement in cardiac performance STUDY OBJECTIVE Noninvasive ventilation has been shown to be effective in patients with acute respiratory failure due to pulmonary edema and exacerbations of COPD . Its role in an acute asthmatic attack , however , is uncertain . The purpose of this pilot study was to compare conventional asthma treatment with nasal bilevel pressure ventilation ( BPV ) [ BiPAP ; Respironics ; Murrysville , PA ] plus conventional treatment in patients with a severe asthmatic attack admitted to the emergency department . DESIGN A prospect i ve , r and omized , placebo-controlled study . SETTING An emergency department at a university hospital . PATIENTS Thirty patients with a severe asthma attack were recruited from a larger group of 124 asthmatic patients seen in the emergency department . Fifteen patients were r and omly assigned to BPV plus conventional therapy and 15 patients to conventional therapy alone . The two groups had similar clinical characteristics on hospital admission . Mean ( + /- SD ) FEV(1 ) on recruitment was 37.3 + /- 10.7 % in the BPV group and 33.8 + /- 10.2 % in the control group ( p = not significant ) . INTERVENTIONS AND MEASUREMENTS BPV with predetermined inspiratory and expiratory pressures was applied for 3 h in the BPV group ; in the control group , a similar sham device with subtherapeutic pressures was applied for 3 h. Bedside lung function test results and vital signs were obtained at baseline , and during and at the completion of the study protocol . RESULTS The use of BPV significantly improved lung function test results . Eighty percents of the patients in the BPV group reached the predetermined primary end points ( an increase of at least 50 % in FEV(1 ) as compared to baseline ) , vs 20 % of control patients ( p < 0.004 ) . Mean rise in FEV(1 ) was 53.5 + /- 23.4 % in the BPV group and 28.5 + /- 22.6 % in the conventional treatment group ( p = 0.006 ) . The intention-to-treat analysis of the secondary end point rate of hospitalization included 33 patients . Hospitalization was required for 3 of 17 patients ( 17.6 % ) in the BPV group , as compared with 10 of 16 patients ( 62.5 % ) in the control group ( p = 0.0134 ) . CONCLUSION In selected patients with a severe asthma attack , the addition of BPV to conventional treatment can improve lung function , alleviate the attack faster , and significantly reduce the need for hospitalization AIMS In acute cardiogenic pulmonary oedema ( ACPE ) , continuous positive airway pressure ( CPAP ) added to medical treatment improves outcome . The present study was design ed to assess the benefit of CPAP as a first line treatment of ACPE in the out-of-hospital environment . METHODS AND RESULTS The protocol lasted 45 min , divided into three periods of 15 min . Patients with ACPE were r and omly assigned in two groups : 1/Early CPAP ( n = 63 ) :  CPAP alone ( T0-T15 ) ; CPAP + medical treatment ( T15-T30 ) ; medical treatment alone ( T30-T45 ) and 2/Late CPAP ( n = 61 ) : medical treatment alone ( T0-T15 ) ; medical treatment + CPAP ( T15-T30 ) ; medical treatment alone ( T30-T45 ) . Primary endpoint : effect of early CPAP on a dyspnoea clinical score and on arterial blood gases . Secondary endpoints : incidence of tracheal intubation , inotropic support , and in-hospital mortality . T0-T15 : CPAP alone had a greater effect than medical treatment on the clinical score ( P = 0.0003 ) and on PaO(2 ) ( P = 0.0003 ) . T15-T30 : adding CPAP to medical treatment ( late CPAP group ) improved clinical score and blood gases and the two groups were no longer different at T30 . T30-T45 : in both groups , CP 
    Output:
    