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American Journal of Respiratory and... Jul 2023Breathing difficulties are highly stressful. In critically ill patients, they are associated with an increased risk of posttraumatic manifestations. Dyspnea, the... (Clinical Trial)
Clinical Trial
Breathing difficulties are highly stressful. In critically ill patients, they are associated with an increased risk of posttraumatic manifestations. Dyspnea, the corresponding symptom, cannot be directly assessed in noncommunicative patients. This difficulty can be circumvented using observation scales such as the mechanical ventilation-respiratory distress observation scale (MV-RDOS). To investigate the performance and responsiveness of the MV-RDOS to infer dyspnea in noncommunicative intubated patients. Communicative and noncommunicative patients exhibiting breathing difficulties under mechanical ventilation were prospectively included and assessed using a dyspnea visual analog scale, MV-RDOS, EMG activity of alae nasi and parasternal intercostals, and EEG signatures of respiratory-related cortical activation (preinspiratory potentials). Inspiratory-muscle EMG and preinspiratory cortical activities are surrogates of dyspnea. Assessments were conducted at baseline, after adjustment of ventilator settings, and, in some cases, after morphine administration. Fifty patients (age, 67 [(interquartile interval [IQR]), 61-76] yr; Simplified Acute Physiology Score II, 52 [IQR, 35-62]) were included, 25 of whom were noncommunicative. Relief occurred in 25 (50%) patients after ventilator adjustments and in 21 additional patients after morphine administration. In noncommunicative patients, MV-RDOS score decreased from 5.5 (IQR, 4.2-6.6) at baseline to 4.2 (IQR, 2.1-4.7; < 0.001) after ventilator adjustments and 2.5 (IQR, 2.1-4.2; = 0.024) after morphine administration. MV-RDOS and alae nasi/parasternal EMG activities were positively correlated (ρ = 0.41 and 0.37, respectively). MV-RDOS scores were higher in patients with EEG preinspiratory potentials (4.9 [IQR, 4.2-6.3] vs. 4.0 [IQR, 2.1-4.9]; = 0.002). The MV-RDOS seems able to detect and monitor respiratory symptoms reasonably well in noncommunicative intubated patients. Clinical trial registered with www.clinicaltrials.gov (NCT02801838).
Topics: Aged; Humans; Dyspnea; Morphine Derivatives; Respiration, Artificial; Respiratory Distress Syndrome; Ventilators, Mechanical
PubMed: 36973007
DOI: 10.1164/rccm.202301-0188OC -
Journal of the Academy of... 2024Consultation-liaison psychiatrists frequently address dyspnea in intensive care unit (ICU) patients. Dyspnea is common in this patient population, but is frequently... (Review)
Review
BACKGROUND
Consultation-liaison psychiatrists frequently address dyspnea in intensive care unit (ICU) patients. Dyspnea is common in this patient population, but is frequently misunderstood and underappreciated in noncommunicative ICU patients.
OBJECTIVE
This paper provides an updated review on dyspnea specifically in the ICU population, including its pathophysiology and management, pharmacological and nonpharmacological, aimed at consultation-liaison psychiatrists consulting in ICU.
METHODS
A literature review was conducted with PubMed, querying published articles for topics associated with dyspnea and dyspnea-associated anxiety in ICU patient populations. When literature in ICU populations was limited, information was deduced from dyspnea and anxiety management from non-ICU populations. Articles discussing the definition of dyspnea, mechanistic pathways, screening tools, and pharmacologic and nonpharmacologic management were included.
RESULTS
A reference guide was created to help consultation-liaison psychiatrists and intensivists in the screening and treatment of dyspnea and dyspnea-associated anxiety in critically ill patients.
CONCLUSIONS
Dyspnea is frequently associated with anxiety, prolonged days on mechanical ventilation, and worse quality of life after discharge. It can also increase the risk of posttraumatic stress disorder post-ICU discharge. However, it is not routinely screened for, identified, or addressed in the ICU. This manuscript provides an updated review on dyspnea and dyspnea-associated anxietyin the ICU population, including its pathophysiology and management, and offers a useful reference for consultation-liaison psychiatrists to provide treatment recommendations.
Topics: Humans; Psychiatrists; Intensive Care Units; Quality of Life; Anxiety; Dyspnea
PubMed: 37952697
DOI: 10.1016/j.jaclp.2023.11.001 -
Transplantation Proceedings Oct 2022Dyspnea is an important problem that might affect the clinical course after lung transplantation; however, the prevalence, risk factors, and relevant outcomes of dyspnea... (Observational Study)
Observational Study
BACKGROUND
Dyspnea is an important problem that might affect the clinical course after lung transplantation; however, the prevalence, risk factors, and relevant outcomes of dyspnea in the intensive care unit (ICU) after lung transplantation remain unknown.
METHODS
This retrospective, observational study enrolled consecutive patients aged ≥ 20 years who were admitted to the ICU after lung transplantation between January 2010 and December 2020. The main outcome measure was provider-documented dyspnea identified based on a comprehensive retrospective chart review to extract dyspnea episodes (e.g., documented words related to "dyspnea," "shortness of breath," or "breathlessness").
RESULTS
This study included 184 lung transplant recipients, including 115 bilateral (63%) and 69 single (37%) lung transplants. Fifty-four transplants were from living donors (29%), and 130 were from deceased donors (71%). Dyspnea was documented in 116 patients (63%). Multivariate analysis identified bilateral lung transplantation (odds ratio = 5.127; 95% confidence interval, 2.020-13.014; P < .001) as a risk factor for dyspnea. In addition, postoperative anxiety (odds ratio = 18.605; 95% confidence interval, 7.748-44.674; P < .001) was independently associated with dyspnea. Patients with documented dyspnea showed delayed rehabilitation (P < .001) and weaning from mechanical ventilation (P < .001) and a longer ICU stay (P < .001).
CONCLUSION
This study demonstrated that the prevalence of dyspnea in the ICU after lung transplantation was frequent and identified bilateral lung transplantation as a risk factor. Dyspnea caused a delay in rehabilitation and weaning from mechanical ventilation. Extensive evaluation and care for dyspnea and anxiety may enhance patient recovery.
Topics: Humans; Retrospective Studies; Length of Stay; Intensive Care Units; Lung Transplantation; Respiration, Artificial; Dyspnea
PubMed: 36180255
DOI: 10.1016/j.transproceed.2022.08.034 -
Ugeskrift For Laeger Jul 2021Patients with emphysema often have limited treatment options. Lung volume reduction is an effective treatment to carefully selected patients with emphysema. Most... (Review)
Review
Patients with emphysema often have limited treatment options. Lung volume reduction is an effective treatment to carefully selected patients with emphysema. Most importantly, the primary care physician should refer patients with COPD and refractory dyspnoea and/or with emphysema to departments specialised in respiratory medicine for further treatment and assessment, which is discussed in this review.
Topics: Dyspnea; Emphysema; Humans; Pneumonectomy; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Treatment Outcome
PubMed: 34356024
DOI: No ID Found -
Pediatric Pulmonology Dec 2021Although prolonged respiratory symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been described in adults, data are emerging...
INTRODUCTION
Although prolonged respiratory symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been described in adults, data are emerging that children also experience long-term sequelae of coronavirus disease 2019 (COVID-19). The respiratory sequelae of COVID-19 in children remain poorly characterized. In this study we describe health data and respiratory findings in pediatric patients presenting with persistent respiratory symptoms following COVID-19.
METHODS
This study included patients referred to Pulmonary Clinic at the Children's Hospital of Philadelphia between December 2020 and April 2021 (n = 29). Inclusion criteria included a history of SARS-CoV-2 RNA positivity or confirmed close household contact and suggestive symptoms. A retrospective chart review was performed and demographic, clinical, imaging, and functional test data were collected.
RESULTS
The mean age at presentation to clinic was 13.1 years (range: 4-19 years). Patients had persistent respiratory symptoms ranging from 1.3 to 6.7 months postacute infection. Persistent dyspnea and/or exertional dyspnea were present in nearly all (96.6%) patients at the time of clinic presentation. Other reported chronic symptoms included cough (51.7%) and exercise intolerance (48.3%). Fatigue was reported in 13.8% of subjects. Many subjects were overweight or obese (62.1%) and 11 subjects (37.9%) had a prior history of asthma. Spirometry and plethysmography were normal in most patients. The six-minute walk test (6MWT) revealed exercise intolerance and significant tachycardia in two-thirds of the nine children tested.
CONCLUSION
Exertional dyspnea, cough and exercise intolerance were the most common respiratory symptoms in children with postacute COVID-19 respiratory symptoms seen in an outpatient pulmonary clinic. Spirometry (and plethysmography when available), however, was mostly normal, and exertional intolerance was frequently demonstrated using the 6MWT.
Topics: Adult; COVID-19; Child; Dyspnea; Humans; RNA, Viral; Retrospective Studies; SARS-CoV-2
PubMed: 34534416
DOI: 10.1002/ppul.25671 -
European Respiratory Review : An... Sep 2023A proportion of coronavirus disease 2019 (COVID-19) survivors experience persistent dyspnoea without measurable impairments in lung function. We performed a systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A proportion of coronavirus disease 2019 (COVID-19) survivors experience persistent dyspnoea without measurable impairments in lung function. We performed a systematic review and meta-analysis to determine relationships between dyspnoea and imaging abnormalities over time in post-COVID-19 patients.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we analysed studies published prior to 15 September 2022 and indexed by Google Scholar, PubMed and LitCOVID which assessed chest imaging in adults ≥3 months after COVID-19. Demographic, chest imaging, spirometric and post-COVID-19 symptom data were extracted. The relationships between imaging abnormalities and dyspnoea, sex and age were determined using a random effects model and meta-regression.
RESULTS
47 studies were included in the meta-analysis (n=3557). The most prevalent computed tomography (CT) imaging abnormality was ground-glass opacities (GGOs) (44.9% (95% CI 37.0-52.9%) at any follow-up time-point). Occurrence of reticulations significantly decreased between early and late follow-up (p=0.01). The prevalence of imaging abnormalities was related to the proportion of patients with dyspnoea (p=0.012). The proportion of females was negatively correlated with the presence of reticulations (p=0.001), bronchiectasis (p=0.001) and consolidations (p=0.025). Age was positively correlated with imaging abnormalities across all modalities (p=0.002) and imaging abnormalities present only on CT (p=0.001) (GGOs (p=0.004) and reticulations (p=0.001)). Spirometric values improved during follow-up but remained within the normal range at all time-points.
CONCLUSIONS
Imaging abnormalities were common 3 months after COVID-19 and their occurrence was significantly related to the presence of dyspnoea. This suggests that CT imaging is a sensitive tool for detecting pulmonary abnormalities in patients with dyspnoea, even in the presence of normal spirometric measurements.
Topics: Adult; Female; Humans; COVID-19; SARS-CoV-2; Lung; Dyspnea; Lung Diseases
PubMed: 37558261
DOI: 10.1183/16000617.0253-2022 -
Annals of Medicine Dec 2022Lymphangioleiomyomatosis (LAM) is associated with progressive dyspnoea and exercise intolerance, but despite the central role of physiotherapy on pulmonary...
BACKGROUND
Lymphangioleiomyomatosis (LAM) is associated with progressive dyspnoea and exercise intolerance, but despite the central role of physiotherapy on pulmonary rehabilitation, there is a huge lack of physiotherapy approaches used specifically for LAM patients.
OBJECTIVE
to identify the physiotherapeutic strategies used in the treatment of patients with LAM.
MATERIALS AND METHODS
This is a systematic review of literature. Searches were performed (in PubMed, Lilacs, Embase and PEDro databases) with the keywords "Lymphangioleiomyomatosis" and "Physiotherapy," and its variations. Articles describing physiotherapy interventions were included in the study. Data extracted from the studies were authors, year, country of publication, sample size, physiotherapy intervention, time/frequency/duration of intervention protocols, instruments used to measure results and main findings. Methodological quality of studies was evaluated by PEDro Scale (clinical trials), Newcastle-Ottawa Scale (NOS; observational studies) and CARE checklist (case reports), respectively.
RESULTS
A total of 82 articles identified, three duplicates were removed, 71 studies were excluded after title and abstract reading and four after full-text reading, all due to absence of association with the study topic. Four studies were included in the present review. Cardiorespiratory physiotherapy with endurance and resistance training were identified as physiotherapeutic strategies to improve lung function, functional capacity, depression symptoms and quality of life in LAM.
CONCLUSIONS
Endurance and resistance training is the keystone for physiotherapy in patients with LAM, but despite the reported benefits, there is a huge lack of studies related to the modalities, safety and dosage of physiotherapy prescription for patients with LAM.KEY MESSAGESLymphangioleiomyomatosis (LAM), a rare disease, leads to progressive dyspnoea and exercise intolerance;Physiotherapy can improve dyspnoea and exercise intolerance in LAM through endurance and resistance exercises.
Topics: Dyspnea; Exercise; Exercise Therapy; Humans; Physical Therapy Modalities; Quality of Life
PubMed: 36217116
DOI: 10.1080/07853890.2022.2128401 -
Ugeskrift For Laeger Sep 2020Dyspnoea is cardinal symptom in chronic obstructive lung disease and common in palliative phases of cancer and other chronic medical diseases. Low-dose opioids is... (Review)
Review
Dyspnoea is cardinal symptom in chronic obstructive lung disease and common in palliative phases of cancer and other chronic medical diseases. Low-dose opioids is frequently used off-label. This review examines the evidence and safety as well as administration forms and pharmacokinetics using low dose opioids for dyspnoea. Conclusively, there seems to be clinical efficacy although further studies are needed. Furthermore, the authors recommend Danish Medical Agency to legislate low-dose morphine to palliative patients with refractory dyspnoea.
Topics: Analgesics, Opioid; Dyspnea; Humans; Morphine; Palliative Care; Pulmonary Disease, Chronic Obstructive
PubMed: 33000737
DOI: No ID Found -
La Revue de Medecine Interne Feb 2023
Topics: Humans; Dermatomyositis; Autoantibodies; Dyspnea
PubMed: 36759078
DOI: 10.1016/j.revmed.2022.10.388 -
Heart & Lung : the Journal of Critical... 2019Pulmonary artery dissection (PAD) is considered to be a rare condition with a very high mortality. Since a comprehensive review on PAD has not yet been done, we analysed... (Review)
Review
Pulmonary artery dissection (PAD) is considered to be a rare condition with a very high mortality. Since a comprehensive review on PAD has not yet been done, we analysed all the available reports on PAD. In this analysis and review we searched the databases; Medline, PubMed Central, Directory of Open Access Journals, Google Scholar using the search term "Pulmonary Artery Dissection" with no language restrictions. In the 150 cases of PAD reported from 1842 to June 2018, the average age at diagnosis was 44.8 years with a male to female ratio of 1.1:1. Diagnosis was made in 49.3% of the males in the third and fourth decades, and 55.4% of the females in the fifth and sixth decades. The primary underlying causes were pulmonary hypertension and heart diseases, both congenital (mainly PDA) and acquired. The commonest clinical presentations were dyspnoea and chest pain. The best investigation of diagnosis was CT scan. The pulmonary trunk was the site of dissection in 72.5%. Surgical treatment, or medical management followed by surgery, had the best success rates. The overall survival rate which was 10.9% up to the year 2000, increased to 59.3% thereafter. If PAD was diagnosed ante-mortem, 70.5% survived. Haemopericardium / cardiac tamponade was seen at autopsy in 84.2%. PAD is not as rare, nor as fatal as believed, and with a high index of suspicion and appropriate investigations, an early diagnosis of PAD can be made and successful treatment instituted.
Topics: Aortic Dissection; Cardiac Tamponade; Dyspnea; Echocardiography; Humans; Magnetic Resonance Imaging, Cine; Pulmonary Artery; Tomography, X-Ray Computed
PubMed: 30910250
DOI: 10.1016/j.hrtlng.2019.02.007