Prehospital PEEP for Acute Respiratory Distress: Protocol for a Scoping Review

Area of Science:

• Emergency Medicine
• Respiratory Medicine
• Critical Care

Background:

• Positive End-Expiratory Pressure (PEEP) improves oxygenation and reduces work of breathing in acute respiratory distress.
• Prehospital use of PEEP-based ventilation (CPAP, BiPAP, APL valves) is inconsistent, with varied evidence across conditions like COPD, asthma, pneumonia, and cardiogenic pulmonary edema.

Purpose of the Study:

• To conduct a scoping review mapping the evidence on prehospital PEEP-based ventilation in adults with acute respiratory distress.
• To identify reported clinical outcomes and safety data associated with prehospital PEEP use.

Main Methods:

• Systematic search of major databases (MEDLINE, Embase, CINAHL, Cochrane) following JBI and PRISMA-ScR guidelines.
• Inclusion of empirical studies (RCTs, observational, case series/reports) on adults (≥18 years) receiving prehospital PEEP-based ventilation.
• Data extraction and narrative synthesis by two independent reviewers, with quality appraisal using Jadad and Newcastle-Ottawa scales.

Main Results:

• Anticipates a limited but relevant body of evidence on prehospital PEEP use.
• Expected findings include effects on oxygenation, dyspnea, advanced airway escalation, adverse events, and feasibility.
• Sparse evidence is expected for prehospital Adjustable Pressure-Limiting (APL) valve systems.

Conclusions:

• This review will comprehensively map prehospital PEEP use in adults with acute respiratory distress.
• It will summarize clinical effects, safety, and feasibility, highlighting research gaps.
• Findings will inform future research directions in prehospital respiratory support.