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Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure
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Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure
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Journal Article
Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure
2024
Overview
Background
Dyspnea is a key symptom of de novo acute hypoxemic respiratory failure. This study explores dyspnea and its association with intubation and mortality in this population.
Methods
This was a secondary analysis of a multicenter, randomized, controlled trial. Dyspnea was quantified by a visual analog scale (dyspnea-VAS) from zero to 100 mm. Dyspnea was measured in 259 of the 310 patients included. Factors associated with intubation were assessed with a competing risks model taking into account ICU discharge. The Cox model was used to evaluate factors associated with 90-day mortality.
Results
At baseline (randomization in the parent trial), median dyspnea-VAS was 46 (interquartile range, 16–65) mm and was ≥ 40 mm in 146 patients (56%). The intubation rate was 45%. Baseline variables independently associated with intubation were moderate (dyspnea-VAS 40–64 mm) and severe (dyspnea-VAS ≥ 65 mm) dyspnea at baseline (sHR 1.96 and 2.61,
p
= 0.023), systolic arterial pressure (sHR 2.56,
p
< 0.001), heart rate (sHR 1.94,
p
= 0.02) and PaO
2
/FiO
2
(sHR 0.34,
p
= 0.028). 90-day mortality was 20%. The cumulative probability of survival was lower in patients with baseline dyspnea-VAS ≥ 40 mm (logrank test,
p
= 0.049). Variables independently associated with mortality were SAPS 2 ≥ 25 (
p
< 0.001), moderate-to-severe dyspnea at baseline (
p
= 0.073), PaO
2
/FiO
2
(
p
= 0.118), and treatment arm (
p
= 0.046).
Conclusions
In patients admitted to the ICU for de novo acute hypoxemic respiratory failure, dyspnea is associated with a higher risk of intubation and with a higher mortality.
Trial registration
: clinicaltrials.gov Identifier # NCT 01320384.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V
Subject
Acute respiratory distress syndrome
/ Aged
/ Analysis
/ Dyspnea
/ Female
/ Humans
/ Intensive Care Units - organization & administration
/ Intensive Care Units - statistics & numerical data
/ Intubation, Intratracheal - methods
/ Intubation, Intratracheal - statistics & numerical data
/ Male
/ Medicine
/ Personalized medicine in the ICU
/ Ratios
/ Respiratory Insufficiency - etiology
/ Respiratory Insufficiency - mortality
/ Respiratory Insufficiency - physiopathology
