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Observational Study
. 2018 Aug 9;52(2):1702637.
doi: 10.1183/13993003.02637-2017. Print 2018 Aug.

Dyspnoea in patients receiving noninvasive ventilation for acute respiratory failure: prevalence, risk factors and prognostic impact: A prospective observational study

Laurence Dangers  1   2 , Claire Montlahuc  3   4 , Achille Kouatchet  5 , Samir Jaber  6   7 , Ferhat Meziani  8 , Sébastien Perbet  9   10 , Thomas Similowski  1   2 , Matthieu Resche-Rigon  3   4 , Elie Azoulay  11 , Alexandre Demoule; REVA Network (Research Network in Mechanical Ventilation) and the Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (GrrrOH); List of contributors who included study patients: Angers University Hospital, Angers, France:
Collaborators, Affiliations
Free article
Observational Study

Dyspnoea in patients receiving noninvasive ventilation for acute respiratory failure: prevalence, risk factors and prognostic impact: A prospective observational study

Laurence Dangers et al. Eur Respir J. .
Free article

Abstract

Dyspnoea is a frequent and intense symptom in intubated patients, but little attention has been paid to dyspnoea during noninvasive mechanical ventilation in the intensive care unit (ICU).The objectives of this study were to quantify the prevalence, intensity and prognostic impact of dyspnoea in patients receiving noninvasive ventilation (NIV) for acute respiratory failure (ARF) based on secondary analysis of a prospective observational cohort study in patients who received ventilatory support for ARF in 54 ICUs in France and Belgium. Dyspnoea was measured by a modified Borg scale.Among the 426 patients included, the median (interquartile range) dyspnoea score was 4 (3-5) on admission and 3 (2-4) after the first NIV session (p=0.001). Dyspnoea intensity ≥4 after the first NIV session was associated with the Sequential Organ Failure Assessment Score (odds ratio (OR) 1.12, p=0.001), respiratory rate (OR 1.03, p=0.032), anxiety (OR 1.92, p=0.006), leaks (OR 2.5, p=0.002) and arterial carbon dioxide tension (OR 0.98, p=0.025). Dyspnoea intensity ≥4 was independently associated with NIV failure (OR 2.41, p=0.001) and mortality (OR 2.11, p=0.009), but not with higher post-ICU burden and altered quality of life.Dyspnoea is frequent and intense in patients receiving NIV for ARF and is associated with a higher risk of NIV failure and poorer outcome.

Trial registration: ClinicalTrials.gov NCT01449331.

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Conflict of interest statement

Conflict of interest: S. Jaber reports personal fees from Fisher and Paykel, Drager, Medtronic and Xenios, outside the submitted work. Conflict of interest: T. Similowski reports personal fees from AstraZeneca, Boehringer Ingelheim France, GSK, Lungpacer Inc, TEVA, Chiesi, Pierre Fabre and Invacare, personal fees and non-financial support from Novartis, outside the submitted work. In addition, T. Similowski has a patent “brain-ventilator interface to improve the detection of dyspnoea” licensed to Air Liquide Medical Systems and MyBrainTechnology. Conflict of interest: E. Azoulay reports grants from the French Ministry of Health, personal fees for lecturing from Alexion, MSD and Baxter, grants and non-financial support (travel expenses) from Pfizer, and personal fees for lecturing and board participation from Gilead, during the conduct of the study. Conflict of interest: A. Demoule reports personal fees and non-financial support from Medtronic, grants, personal fees and non-financial support from Philips, grants and personal fees from Resmed and Fisher and Paykel, personal fees from Baxter and Hamilton, and grants from the French Ministry of Health, outside the submitted work.

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