Validation of an Observational Scale of Dyspnea in Non-communicating Patients in the ICU
Status:
Completed
Trial end date:
2017-07-28
Target enrollment:
Participant gender:
Summary
Background : Dyspnea is common and severely impact mechanically ventilated patients outcomes
in intensive care unit (ICU). Recognize, measure and treat dyspnea have become current major
therapeutic challenge. Its measurement involves a self-assessment by the patient, and by
definition, a certain level of communication. Consequently, a large proportion of the
ICU-population (non-communicating) misses its evaluation and potential benefits associated
with its control. In other hand, electrophysiological markers that help to detect and
quantify dyspnea regardless of the patient's cooperation, has been developed and validated as
dyspnea surrogate, namely: 1) the electromyographic (EMG) activity of extra diaphragmatic
inspiratory muscles and 2) the premotor inspiratory potentials (PIP) detected on the
electroencephalogram (EEG). Because of its complex implementation in daily practice the
research team has developed alternatively a behavioral score called IC-RDOS that provides
reliable dyspnea assessment also without patient participation. Validated in conscious
patients, it has not been yet validated in non-communicating patients.
Hypothesis : The IC-RDOS is valid for non-communicating ventilated patients and allows a
simple and reliable assessment of dyspnea in this specific population.
Objective : To validate the IC-RDOS in non-communicating ICU patients under mechanical
ventilation, using comparison with the tools validated for reliable measure of dyspnea in
non-communicating patients (EMG, EEG).
Patients and Methods: In 40 patients will be collected simultaneously IC-RDOS, PIP (EEG) and
electromyographic activity of three extra diaphragmatic inspiratory muscles (scalene,
parasternal and Alae nasi) before and after intervention therapy aiming at reduce dyspnea
(ventilator settings or pharmacological intervention), initiated by the clinician in charge
of the patient.
Expected results : Observe a strong positive correlation between the IC-RDOS and
electrophysiological markers (amplitude of the electromyogram and presence and magnitude of
PIP). Observe a correlation between changes in the IC-RDOS and the electrophysiological
markers after therapeutic interventions.
Optimizing patient comfort is a prominent concern in the ICU. By optimizing the detection and
quantification of dyspnea in non-communicating patients, this study should ultimately improve
the management and "the better living" of ventilated patients in intensive care