Abstract
BACKGROUND: The association between dyspnea and mortality has not been demonstrated in the ICU setting. We tested the hypothesis that dyspnea (self-reported respiratory discomfort) or its observational correlates (5-item intensive care Respiratory Distress Observation Scale [IC-RDOS]) assessed on ICU admission would be associated with ICU mortality.
METHODS: Ancillary analysis of single-center data prospectively collected from 220 communicative ICU subjects allocated to a derivation cohort of 120 subjects and a separate validation cohort of 100 subjects. Dyspnea was assessed dichotomously (yes/no), with a dyspnea visual analog scale (measured in mm), and IC-RDOS was calculated. Multivariate logistic regression was used to identify factors associated with ICU and hospital mortality.
RESULTS: Dyspnea was reported by 69 (58%; median 45 [interquartile range [IQR] 32–60] mm) and 47 (47%; 38 [IQR 26–48] mm) subjects in the derivation and validation cohorts, respectively. IC-RDOS was 2.3 (1.2–3.1) and 2.4 (1.3–2.8), respectively. IC-RDOS values were higher in subjects with dyspnea than in subjects without dyspnea in both the derivation cohort (2.6 [2.2–4.6] vs 1.4 [0.9–2.4], P < .001) and the validation cohort (2.6 [2.3–4.4] vs 2.2 [1.0–2.8], P < .001). On multivariate analysis of the derivation cohort, admission for hemorrhagic shock (odds ratio 13.98), IC-RDOS (odds ratio 1.77), and Simplified Acute Physiology Score II (odds ratio 1.10) was associated with ICU mortality. Areas under the receiving operating characteristic curve of IC-RDOS to predict ICU mortality were 0.785 and 0.794 in the derivation and validation cohorts, respectively.
CONCLUSIONS: IC-RDOS, an observational correlate of dyspnea, but not dyspnea itself, was associated with higher mortality in ICU subjects.
- dyspnea
- dyspnea observation scale
- ICU
- multidimensional dyspnea profile
- prognosis
Footnotes
- Correspondence: Maxens Decavèle MD, Department of Respiratory and Critical Care Medicine, Groupe Hospitalier Pitié-Salpêtrière, 47–83 Boulevard de l'Hôpital, 75013 Paris, France; phone: 33-1-42-16-77-61; Fax: 33-1-42-16-78-43. E-mail: maxens.decavele{at}aphp.fr
Drs Demoule and Similowski are co-senior authors.
Dr Decavèle discloses a relationship with ISIS Medical. Dr Similowski discloses relationships with AstraZeneca France, Boerhinger Ingelheim France, Novartis France, Teva France, Chiesi France, Lungpacer, ADEP Assistance, and Air Liquide Medical Systems. Dr Demoule discloses relationships with Philips, Baxter, Fisher & Paykel, French Ministry of Health, Getinge, Respinor, Lungpacer, Löwenstein, and Gilead. Dr Dres discloses relationships with Lungpacer and BioSerenity. Dr Morélot-Panzini discloses relationships with AstraZeneca, GlaxoSmithKline, SOS Oxygène, ADEP, ISIS, ResMed, Chiesi, Menarini, Vivisol, Air Liquide, Löwenstein, and Fisher & Paykel. Dr Mayaux discloses a relationship with Gilead France. The remaining authors have disclosed no conflicts of interest.
The study was performed at Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France.
This study was supported by the program Investissement d'Avenir ANR-10-AIHU 06 of the French Government (Agence Nationale pour la Recherche) and allows Dr Persichini's salary.
The data sets analyzed during the current study are available from the corresponding author on reasonable request.
Supplementary material related to this paper is available at http://rc.rcjournal.com.
- Copyright © 2022 by Daedalus Enterprises
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