Device Measured Rapid Shallow Breathing Index and not Minute Ventilation Reflects Changes in Dyspnea Status in Ambulatory Heart Failure Patients (original) (raw)

Design and Rationale of the URGENT Dyspnea Study: An International, Multicenter, Prospective Study

American Journal of Therapeutics, 2008

Background: Dyspnea is a key target in both clinical management and clinical trials of acute heart failure syndromes and its relief important to patients, clinicians, investigators, and regulatory approval agencies. Despite its importance, the impact of early therapy on dyspnea is not well known. The severity of dyspnea may also be influenced by the conditions under which it is measured (ie, sitting up or lying down). URGENT Dyspnea (Ularitide Global Evaluation in Acute Decompensated Heart Failure) is a prospective multicenter study designed to address these issues. Methods and Results: Consenting adult patients with dyspnea secondary to acute heart failure syndromes are eligible. Patients must be interviewed within one hour of first physician evaluation, typically in an emergency department or acute care setting, with dyspnea assessed by the patient using both a 5-point Likert scale and 10-point visual analog scale in the sitting (60°) and then supine (20°) position if symptomatically able. Improvement of dyspnea by change in Likert and visual analog scale scores at 6 h is the primary endpoint. Conclusions: Timing of dyspnea measurement and the conditions under which it is measured may influence dyspnea severity and this may have significant implications for future acute heart failure syndromes clinical trial design that target dyspnea.

Evaluation of clinical methods for rating dyspnea

Chest, 1988

To evaluate available clinical methods (self ratings and questionnaire) for rating dyspnea, we (1) compared scores from the recently developed baseline dyspnea index (BDI) with the Medical Research Council (MRC) scale and the oxygen-cost diagram (OCD) in 133 patients with various respiratory diseases who sought medical care for shortness of breath; and (2) evaluated the relationships between dyspnea scores and standard measures of physiologic lung function in the same patients. The dyspnea scores were all significantly correlated (r=O.48 to 0.70; p<O.OOl). Agreement between two observers or with repeated use was satisfactory with all three clinical rating methods.

Time course of dyspnea evolution in the emergency department: results from the URGENT dyspnea survey

Critical Care, 2009

Introduction There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.

Dyspnea: Measurement and Evaluation

Cardiopulmonary Physical Therapy Journal, 1999

Physical therapists treat patients exhibiting dyspnea as the primary cause of functional limitation and disability. Dyspnea, or the patient's subjective perception of shortness of breath, may be caused by a wide variety of diagnoses or dysfunction. Although the mechanisms for dyspnea are not fully known, health care practitioners need to be able to evaluate and monitor dyspnea in their patients in order to help them progress to the highest possible functional outcome. A discussion of many possible causes of dyspnea will be presented. In addition a variety of dyspnea scales will be presented to guide the therapist in making objective measurement of the patient's dyspnea as a baseline and during treatment to document progress. A new algorithm will be presented utilizing the presentation of the Guide to Physical Therapist Practice, which tries to identify various body system and impairment causes for dyspnea that the therapist can evaluate. This algorithm will help health care practitioners to understand the role of dyspnea in limiting function and help to evaluate and progress patient treatment in light of the effects of dyspnea.

Pulse and systolic pressure variation assessment in partially assisted ventilatory support

Critical Care, 2009

Introduction There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

American Journal of Respiratory and Critical Care Medicine, 2012

Background: Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. Purpose: The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea. Methods: An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members. Results: Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. Conclusions: Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.

Measurement of dyspnea in chronic obstructive pulmonary disease: what is the tool telling you?

Chronic respiratory disease, 2004

Dyspnea is the most common symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and is linked to decreases in patient activity levels and quality of life. Use of standardized tools to measure dyspnea has a long history in respiratory care. However, in many cases it is not clear what is being quantified when using a particular tool. This review will consider the definition of and mechanisms believed to contribute to dyspnea, attempting to clarify what is being quantified in common tools currently available for dyspnea measurement.

Repeatability of the Evaluation of Perception of Dyspnea in Normal Subjects Assessed Through Inspiratory Resistive Loads

The Open Respiratory Medicine Journal, 2014

Purpose: Study the repeatability of the evaluation of the perception of dyspnea using an inspiratory resistive loading system in healthy subjects. Methods: We designed a cross sectional study conducted in individuals aged 18 years and older. Perception of dyspnea was assessed using an inspiratory resistive load system. Dyspnea was assessed during ventilation at rest and at increasing resistive loads (0.6, 6.7, 15, 25, 46.7, 67, 78 and returning to 0.6 cm H2O/L/s). After breathing in at each level of resistive load for two minutes, the subject rated the dyspnea using the Borg scale. Subjects were tested twice (intervals from 2 to 7 days). Results: Testing included 16 Caucasian individuals (8 male and 8 female, mean age: 36 years). The median scores for dyspnea rating in the first test were 0 at resting ventilation and 0, 2, 3, 4, 5, 7, 7 and 1 point, respectively, with increasing loads. The median scores in the second test were 0 at resting and 0, 0, 2, 2, 3, 4, 4 and 0.5 points, res...

Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea

Heart & lung : the journal of critical care, 2017

Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established. We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard ('minimally improved or worse'). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale ('minimally worse', ...