Diagnostic Accuracy of Respiratory Distress Observation Scales as Surrogates of Dyspnea Self-report in Intensive Care Unit Patients
Diagnostic Accuracy of Respiratory Distress Observation Scales as Surrogates of Dyspnea Self-report in Intensive Care Unit Patients
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DOI：
10.1097/aln.0000000000000805
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发表时间：
2015-10-01
期刊：
影响因子：
8.8
通讯作者：
Similowski, Thomas
中科院分区：
文献类型：
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作者：
Persichini, Romain;Gay, Frederick;Similowski, Thomas
背景：呼吸困难，像疼痛一样，可以给重症监护病房（ICU）患者带来严重的痛苦。其评价依赖于自我报告；因此，当语言交流受损时，有被忽视的风险。包含呼吸和行为体征的观察量表（呼吸窘迫观察量表[RDOS]）可以在类似的临床环境（姑息治疗）中提供呼吸困难自我报告的替代品。方法：前瞻性研究（单中心，16床ICU，大型大学医院）交流ICU患者220例（衍生队列，120例；单独验证队列，100例）。通过呼吸困难视觉模拟量表（D-VAS）评估呼吸困难，并根据其八个组成部分（心率、呼吸频率、无目的运动、吸气时颈部肌肉使用、腹部矛盾、呼气末呼噜声、鼻部张开和面部恐惧表情）计算RDOS。迭代主成分分析和偏最小二乘回归过程旨在确定优化的D-VAS相关性（重症监护RDOS [IC-RDOS]）。结果：在衍生队列中，RDOS与D-VAS显著相关（r = 0.43; 95% CI, 0.29 ~ 0.58）。五项IC-RDOS（心率、吸气时颈部肌肉使用、腹部矛盾、恐惧的面部表情和补充氧气）与D-VAS的相关性显著更好（r = 0.61; 95% CI， 0.50至0.72）。IC-RDOS预测D-VAS的受试者工作曲线下面积中位数为0.83（四分位数间距为0.81 ~ 0.84）。IC-RDOS为2.4，预测D-VAS为4或更高，具有相同的敏感性和特异性（72%）；IC-RDOS为6.3，预测D-VAS为4或更高，特异性为100%。在验证队列中也发现了类似的结果。结论：可观察到的体征组合与通信ICU患者呼吸困难相关。未来需要对缺乏交流的患者进行研究，以确定对治疗干预的反应性和临床有效性。
Background: Dyspnea, like pain, can cause major suffering in intensive care unit (ICU) patients. Its evaluation relies on self-report; hence, the risk of being overlooked when verbal communication is impaired. Observation scales incorporating respiratory and behavioral signs (respiratory distress observation scales [RDOS]) can provide surrogates of dyspnea self-report in similar clinical contexts (palliative care).Methods: The authors prospectively studied (single center, 16-bed ICU, large university hospital) 220 communicating ICU patients (derivation cohort, 120 patients; separate validation cohort, 100 patients). Dyspnea was assessed by dyspnea visual analog scale (D-VAS) and RDOS calculated from its eight components (heart rate, respiratory rate, nonpurposeful movements, neck muscle use during inspiration, abdominal paradox, end-expiratory grunting, nasal flaring, and facial expression of fear). An iterative principal component analysis and partial least square regression process aimed at identifying an optimized D-VAS correlate (intensive care RDOS [IC-RDOS]).Results: In the derivation cohort, RDOS significantly correlated with D-VAS (r = 0.43; 95% CI, 0.29 to 0.58). A five-item IC-RDOS (heart rate, neck muscle use during inspiration, abdominal paradox, facial expression of fear, and supplemental oxygen) significantly better correlated with D-VAS (r = 0.61; 95% CI, 0.50 to 0.72). The median area under the receiver operating curve of IC-RDOS to predict D-VAS was 0.83 (interquartile range, 0.81 to 0.84). An IC-RDOS of 2.4 predicted D-VAS of 4 or greater with equal sensitivity and specificity (72%); an IC-RDOS of 6.3 predicted D-VAS of 4 or greater with 100% specificity. Similar results were found in the validation cohort.Conclusions: Combinations of observable signs correlate with dyspnea in communicating ICU patients. Future studies in noncommunicating patients will be needed to determine the responsiveness to therapeutic interventions and clinical usefulness.