Early Dyspnea Research Articles

Comment on: Benefits of tolvaptan on early dyspnea relief in patients with acute heart failure: A meta-analysis.

Comment on: Benefits of tolvaptan on early dyspnea relief in patients with acute heart failure: A meta-analysis.

Benefits of tolvaptan on early dyspnea relief in patients with acute heart failure: A meta-analysis.

Considering the prevalence of dyspnea in acute heart failure (AHF), its reduction is important to both patients and caregivers. This meta‐analysis was performed to determine the efficacy and safety of tolvaptan on early dyspnea relief in patients with AHF. A systematic search was made of PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov, without language restrictions. Randomized controlled trials (RCTs) on treatment of AHF with tolvaptan, compared with placebo or blank, were reviewed. Studies were pooled to relative risk (RR), with 95% confidence interval (CI). Five RCTs (enrolling 4857 participants) met the inclusion criteria. Tolvaptan presented significant effects on 12 h dyspnea relief (RR: 1.98; 95% CI: 1.24−3.15; p = .004), 24 h/day 1 dyspnea relief (RR: 1.15; 95% CI: 1.07−1.24; p = .0003), 48 h dyspnea relief (RR: 1.20; 95% CI: 1.06−1.36; p = .004), and 72 h dyspnea relief (RR: 1.18; 95% CI: 1.02−1.37; p = .03). No significant increase was noticed in the incidence of worsening renal function in tolvaptan group (RR: 1.10; 95% CI: 0.87−1.39; p = .43). Tolvaptan treatment significantly improved patient‐assessed dyspnea early and persistently in patients with AHF.

Prevention and Treatment of Life-Threatening COVID-19 May Be Possible with Oxygen Treatment.

Most SARS CoV-2 infections probably occur unnoticed or cause only cause a mild common cold that does not require medical intervention. A significant proportion of more severe cases is characterized by early neurological symptoms such as headache, fatigue, and impaired consciousness, including respiratory distress. These symptoms suggest hypoxia, specifically affecting the brain. The condition is best explained by primary replication of the virus in the nasal respiratory and/or the olfactory epithelia, followed by an invasion of the virus into the central nervous system, including the respiratory centers, either along a transneural route, through disruption of the blood-brain barrier, or both. In patients, presenting with early dyspnea, the primary goal of therapy should be the reversal of brain hypoxia as efficiently as possible. The first approach should be intermittent treatment with 100% oxygen using a tight oronasal mask or a hood. If this does not help within a few hours, an enclosure is needed to increase the ambient pressure. This management approach is well established in the hypoxia-related diseases in diving and aerospace medicine and preserves the patient’s spontaneous breathing. Preliminary research evidence indicates that even a small elevation of the ambient pressure might be lifesaving. Other neurological symptoms, presenting particularly in long COVID-19, suggest imbalance of the autonomous nervous system, i.e., dysautonomia. These patients could benefit from vagal nerve stimulation.

Long COVID a New Derivative in the Chaos of SARS-CoV-2 Infection: The Emergent Pandemic?

Coronavirus disease 2019 (COVID-19) is a multisystem illness caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can manifest with a multitude of symptoms in the setting of end-organ damage, though it is predominantly respiratory. However, various symptoms may remain after acute SARS-CoV-2 infection, and this condition is referred to as “Long COVID” (LC). Patients with LC may develop multi-organ symptom complex that remains 4–12 weeks after the acute phase of illness, with symptoms intermittently persisting over time. The main symptoms are fatigue, post-exertional malaise, cognitive dysfunction, and limitation of functional capacity. Pediatric patients developed the main symptoms of LC like those described in adults, although there may be variable presentations of LC in children. The underlying mechanisms of LC are not clearly known, although they may involve pathophysiological changes generated by virus persistence, immunological alterations secondary to virus–host interaction, tissue damage of inflammatory origin and hyperactivation of coagulation. Risk factors for developing LC would be female sex, more than five early symptoms, early dyspnea, previous psychiatric disorders, and alterations in immunological, inflammatory and coagulation parameters. There is currently no specific treatment for LC, but it could include pharmacological treatments to treat symptoms, supplements to restore nutritional, metabolic, and gut flora balance, and functional treatments for the most disabling symptoms. In summary, this study aims to show the scientific community the current knowledge of LC.

DYSPNEA IMPROVEMENT IN PATIENTS WITH LUNG DISEASES IN A SINGLE SESSION OF MINDFUL BREATHING: A RANDOMIZED CONTROLLED STUDY

Background and Aims: Mindful breathing has been practised in recent decades and there is a lack of study for it as a nonpharmacological method in improving dyspnea. This study was to assess the efficacy of mindful breathing in improvement of dyspnea score, oxygen saturation and respiratory rate in patients with lung diseases. Methods: Sixty three inward patients, diagnosed with lung cancer, acute exacerbation of bronchial asthma (AEBA) or acute exacerbation of chronic obstructive pulmonary disease (AECOPD), were recruited and assigned randomly into intervention and control groups. They reported their dyspnea score according to Modified Borg Dyspnea scale while oxygen saturation and respiratory rate were measured. The parameters were assessed at baseline, at 5 mins and at 20 mins. Results: Mindful breathing significantly reduced the dyspnea score among all patients in 5 min (OR = 12.886, 95% CI = 3.588, 46.282 , P < 0.001) and 20 minutes (OR = 5.378, 95% CI = 1.832, 15.790, P = 0.002), oxygen saturation in 5 min (OR = 4.050, 95% CI = 1.137, 14.432, P = 0.025) and respiratory rate in 20 min (OR = 3.069, 95% CI = 1.094, 8.613, P = 0.031). Significant early dyspnea score reduction was observed in 5 min in mindful breathing group among patients with lung cancer. (P = 0.041) In a subgroup of patients with AEBA, mindful breathing conferred significant sustained dyspnea reduction in 5 min (P = 0.006); in 20 min (P = 0.003) and early oxygen saturation in 5 min (P = 0.039). In mindful breathing group among patients with AECOPD, a significant reduction in dyspnea score was observed in 5 minute (P = 0.034) while delayed respiratory rate improvement was demonstrated in 20 min (P = 0.035). Conclusion: Mindful breathing is a quick, easy and useful therapy and has a significant effect in dyspnea reduction among patients with lung diseases. Further studies with a larger sample size are recommended to discover more potential effects of mindful breathing in the subgroups of patients.

Effect of administered corticosteroids for alleviating dyspnea in patients with terminal cancer: a prospective observational approach

Our primary objective was to prospectively evaluate the effects of corticosteroids on dyspnea in terminal cancer patients at Kasugai Municipal Hospital using the Japanese version of the Support Team Assessment Schedule (STAS-J). Our secondary objective was to report the side effects of corticosteroid use in these patients. The prospective investigation included two female patients with terminal breast cancer (Patients 1 and 2, ages 53 and 57 years, respectively) who satisfied the consecutive selection criteria and were hospitalized at Kasugai Municipal Hospital between January 2016 and March 2017. We used both interviews and a review of clinical records to evaluate these patients’ responses to oral or intravenous corticosteroid therapy for dyspnea. Patient 1 had an initial STAS-J dyspnea scale score of 4 before the commencement of corticosteroid administration, which decreased to scores of 2 (day 1) and 1 (day 2 and day 3) after corticosteroid administration. Patient 2 had an initial STAS-J scale score of 3, which decreased to 1 on day 1 and was maintained at this level until death occurred on day 15. Both patients experienced rapid relief of dyspnea (within 24 hours), indicating that corticosteroids may be used to effectively treat early dyspnea experienced by terminal cancer patients.

Hospitalization for Recently Diagnosed Versus Worsening Chronic Heart Failure: From the ASCEND-HF Trial

BackgroundIt is unclear how patients hospitalized for acute heart failure (HF) who are long-term chronic HF survivors differ from those with more recent HF diagnoses. ObjectivesThe goal of this study was to evaluate the influence of HF chronicity on acute HF patient profiles and outcomes. MethodsThe ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial randomized 7,141 hospitalized patients with acute HF with reduced or preserved ejection fraction (EF) to receive nesiritide or placebo in addition to standard care. The present analysis compared patients according to duration of HF diagnosis before index hospitalization by using pre-specified cutoffs (0 to 1 month [i.e., “recently diagnosed”], >1 to 12 months, >12 to 60 months, and >60 months). ResultsOverall, 5,741 (80.4%) patients had documentation of duration of HF diagnosis (recently diagnosed, n = 1,536; >1 to 12 months, n = 1,020; >12 to 60 months, n = 1,653; and >60 months, n = 1,532). Across HF duration groups, mean age ranged from 64 to 66 years, and mean ejection fraction ranged from 29% to 32%. Compared with patients with longer HF duration, recently diagnosed patients were more likely to be women with nonischemic HF etiology, higher baseline blood pressure, better baseline renal function, and fewer comorbidities. After adjustment, compared with recently diagnosed patients, patients with longer HF duration were associated with more persistent dyspnea at 24 h (>1 to 12 months, odds ratio [OR]: 1.20; 95% confidence interval [CI]: 0.97 to 1.48; >12 to 60 months, OR: 1.34; 95% CI: 1.11 to 1.62; and >60 months, OR: 1.31; 95% CI: 1.08 to 1.60) and increased 180-day mortality (>1 to 12 months, hazard ratio [HR]: 1.89; 95% CI: 1.35 to 2.65; >12 to 60 months, HR: 1.82; 95% CI: 1.33 to 2.48; and >60 months, HR: 2.02; 95% CI: 1.47 to 2.77). The influence of HF duration on mortality was potentially more pronounced among female patients (interaction p = 0.05), but did not differ according to age, race, prior ischemic heart disease, or ejection fraction (all interactions, p ≥ 0.23). ConclusionsIn this acute HF trial, patient profile differed according to duration of the HF diagnosis. A diagnosis of HF for ≤1 month before hospitalization was independently associated with greater early dyspnea relief and improved post-discharge survival compared to patients with chronic HF diagnoses. The distinction between de novo or recently diagnosed HF and worsening chronic HF should be considered in the design of future acute HF trials. (A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure; NCT00475852)

Ventilação não invasiva na capacidade funcional de cardiopatas com fração de ejeção ventricular normal

Introdução: A insuficiência cardíaca (IC) é um problema de saúde pública com altos níveis de morbimortalidade apresentando como sinais clínicos característicos a fadiga e dispneia precoce que geram limitações funcionais. Objetivo: Avaliar os efeitos da ventilação não invasiva (VNI) na capacidade funcional de portadores de insuficiência cardíaca estável com fração de ejeção normal, avaliada através do teste da caminhada de seis minutos em esteira (TC6est). Métodos: Após a avaliação das provas de função pulmonar, os pacientes com IC estudados foram submetidos aos seguintes testes: 3 TC6est (uso prévio da VNI por 30 minutos, com uso da VNI durante o teste e sem uso da VNI) e a um teste de caminhada de 6 minutos em solo (TC6’). Nós comparamos a distância percorrida e variáveis cardiorrespiratórias: antes, durante e após os testes da caminhada. Resultados: Participaram do estudo 13 pacientes com IC classe funcional II e III (NYHA). Na prova de função pulmonar 3 participantes apresentaram distúrbio ventilatório restritivo e 8 pacientes apresentaram redução das pressões respiratórias máximas. Não foi observada diferença estatisticamente significativa na distância percorrida entre os quatro testes realizados (p=0,986). Na análise das variáveis cardiorrespiratórias durante os 3 TC6est pôde-se observar apenas diferença estatística significativa na frequência respiratória no sexto minuto (f6’) entre os testes de 30’ antes de VNI X VNI durante (p=0,026), sendo inferior no teste com a aplicação de VNI durante. Conclusão: Apesar do comprometimento da capacidade funcional e da função pulmonar, os portadores de insuficiência cardíaca com fração de ejeção normal estudados não tiveram aumento da distância percorrida no teste de caminhada em esteira com a utilização do suporte ventilatório não–invasivo.

Sex differences in early dyspnea relief between men and women hospitalized for acute heart failure: insights from the RELAX-AHF study

AimsWomen with heart failure are typically older, and more often have hypertension and a preserved left ventricular ejection fraction as compared with men. We sought to analyze if these sex differences influence the course and outcome of acute heart failure.Methods and resultsWe analyzed sex differences in acute heart failure in 1161 patients enrolled in the RELAX-AHF study. The pre-specified study endpoints were used. At baseline, women (436/1161 patients) were older, had a higher left ventricular ejection fraction, a higher rate of hypertension, and were treated differently from men. Early dyspnea improvement (moderate or marked dyspnea improvement measured by Likert scale during the first 24 h) was greater in women. However, dyspnea improvement over the first 5 days (change from baseline in the visual analog scale area under the curve (VAS AUC) to day 5) was similar between men and women. Women reported greater improvements in general wellbeing by Likert, but no such benefits were evident with the VAS score. Multi-variable predictors of moderate or marked dyspnea improvement were female sex (p = 0.0011), lower age (p = 0.0026) and lower diuretic dose (p = 0.0067). The additional efficacy endpoints of RELAX-AHF were similar between men and women and serelaxin was equally effective in men and women.ConclusionsWomen exhibit better earlier dyspnea relief and improvement in general wellbeing compared with men, even adjusted for age and left ventricular ejection fraction. However, in-hospital and post-discharge clinical outcomes were similar between men and women.This trial is registered at ClinicalTrials.gov, NCT00520806.

Abstract 13158: Hospitalization for De Novo versus Worsening Chronic Heart Failure: Insights From the ASCEND-HF Trial

Introduction: Heart failure (HF) is a heterogeneous syndrome and individual patient survival varies widely. It is unclear how hospitalized acute HF (AHF) patients who are long-term chronic HF survivors differ from those with more recent HF diagnoses. Methods: The ASCEND-HF trial randomized 7,141 hospitalized AHF patients with reduced or preserved ejection fraction (EF) to nesiritide or placebo in addition to standard care. The present analysis compared patients by duration of HF diagnosis prior to index hospitalization using pre-specified cutpoints (0-1 month [i.e. “ de novo ”], &gt;1-12 months, &gt;12-60 months, &gt;60 months). Results: Overall, 5,741 (80.4%) patients had documentation of duration of HF diagnosis ( de novo , N=1536; &gt;1-12 months, N=1020; &gt;12-60 months, N=1653; &gt;60 months, N=1532). Mean age ranged from 64-66 years and mean EF from 29-32% across all HF duration groups. Compared to patients with longer HF duration, de novo patients were more likely to have non-ischemic HF etiology, fewer comorbidities, lower natriuretic peptide levels, and better baseline functional status (all P-value &lt;0.01). After adjustment, compared to de novo patients, longer HF duration was associated with more persistent dyspnea at 24 hours and increased 180-day mortality (Table). The influence of HF duration on mortality did not differ by age, gender, race, etiology of HF, or EF (all P-value for interaction ≥0.05). Conclusion: In this large AHF trial cohort, patient profile differed by duration of the HF diagnosis. De novo HF diagnosis was independently associated with greater early dyspnea relief and improved post-discharge survival compared to those with chronic HF diagnoses.

Changes in Dyspnea Status During Hospitalization and Postdischarge Health-Related Quality of Life in Patients Hospitalized for Heart Failure: Findings From the EVEREST Trial

Dyspnea is the most common symptom among hospitalized patients with heart failure and represents a therapeutic target. However, the association between short-term dyspnea relief and postdischarge clinical outcomes and health-related quality of life (HRQOL) remains uncertain. A post hoc analysis was performed of the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which enrolled 4133 patients within 48 hours of admission for heart failure with an ejection fraction ≤40%. Physician-assessed dyspnea was recorded on a daily basis from baseline until discharge or day 7 as none, seldom, frequent, or continuous. Patient-reported dyspnea was measured using a 7-point Likert scale, and patients experiencing moderate or marked dyspnea improvement on day 1 were classified as early responders. The Kansas City Cardiomyopathy Questionnaire summary score, which ranges from 0 to 100, was collected postdischarge at week 1. The primary outcome was unfavorable HRQOL, defined a priori as a Kansas City Cardiomyopathy Questionnaire score <45. Secondary outcomes included 30-day all-cause mortality, and all-cause and cause-specific hospitalizations. The final analytic cohort included 1567 patients discharged alive with complete HRQOL data. Patients were 66.0±12.7 years old and had a mean ejection fraction of 25±8%. Physician-assessed dyspnea was rated as frequent or continuous in 1399 patients (90%) at baseline, which decreased to 250 patients (16%) by discharge, whereas patient-reported early dyspnea relief was reported by 610 patients (40%). The median Kansas City Cardiomyopathy Questionnaire score at week 1 was 50 (35, 65). All-cause mortality was 3.0%, and all-cause hospitalization was 20.5% within 30 days of discharge. Physician-assessed and patient-reported dyspnea was not independently associated with HRQOL, all-cause mortality, or all-cause or cause-specific hospitalization. In-hospital physician-assessed, and patient-reported dyspnea was not independently associated with postdischarge HRQOL, survival, or readmissions. Although dyspnea relief remains a goal of therapy for hospitalized patients with heart failure with reduced ejection fraction, this measure may not be a reliable surrogate for long-term patient-centered or hard clinical outcomes. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.

The clinical comparative study of preterm respiratory distress syndrome and transient tachypnea of newborn

To completely compare the risk factors, respiratory therapies and complications between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) in preterm infants. Data were collected from preterm infants in Department of NICU, Peking University Third Hospital from January, 2013 to December, 2013. Components of clinical variables, including perinatal risk factors, ventilation therapies, pulmonary surfactant (PS) therapy, blood gas analysis and complications, were retrospectively analyzed. χ² test or Fisher's test or t test were used. Ninety-nine preterm infants mean gestational age was (31.9 ± 2.2) weeks and birth weight was (1 661 ± 501) g . Sixty-nine infants were diagnosed with TTN and 30 were diagnosed with RDS. There were significant differences in gestational age ((29.5 ± 2.5) vs. (32.0 ± 3.2) weeks, t = 6.046, P = 0.002), birth weight ((1 115 ± 415) vs. (1 660 ± 531) g, t = 5.916, P = 0.001). Nine cases in the RDS group had Apgar score ≤ 7 while four cases in the TTN group had Apgar score ≤ 7 (P = 0.001). Fourteen cases in RDS group were born through C-section while 55 cases of TTN group were born through C-section (P = 0.025). During 0-2 hours after birth, pH (7.25 ± 0.09 vs. 7.30 ± 0.01, t = -2.144, P = 0.046) was significantly lower in the RDS group. PaO₂((55 ± 20) vs. (41 ± 2) mmHg, 1 mmHg = 0.133 kPa, t = 2.963, P = 0.001) and oxigination index (OI) ((149 ± 58) vs.(100 ± 9) mmHg, t = 3.379, P = 0.003) were significantly lower in the TTN group. In the RDS group, all cases received PS therapy. Twenty-five cases received mechanical ventilation and five cases received noninvasive ventilation. In the TTN group, 12 cases received PS therapy. Forty-four cases received noninvasive ventilation and 25 cases received oxygen inhalation. The cases developing complications, including ventilator associated pneumonia (14(46.7%) vs.4(5.8%), P = 0.038), patent ductus arteriosus (19(63.3%) vs. 9(13.0%), P = 0.025), intraventricular hemorrhage (9(30.0%) vs. 2(2.9%), P = 0.041), bronchopulmonary dysplasia (12(40.0%) vs. 5(7.2%), P = 0.019), were significantly more in the RDS group. RDS and TTN are common causes leading to early dyspnea in preterm infants. Preterm infants with RDS are characterized by younger gestational age, lower birth weight, severer acidosis and more complications. Preterm infants with TTN show lower hypoxemia and OI.

Early and Severe Dyspnea After Supracricoid Partial Laryngectomy

We present the case of a not-yet-reported complication that occurred during the immediate postoperative period after supracricoid partial laryngectomy. We include a review of the literature on complications following this procedure, emphasizing technical considerations that are critical during this surgery. Clinical, diagnostic, and operative findings are presented, as is a differential diagnosis for early and severe postoperative dyspnea following supracricoid laryngectomy.

Predictors of early dyspnoea relief in acute heart failure and the association with 30‐day outcomes: findings from ASCEND‐HF

To examine the characteristics associated with early dyspnoea relief during acute heart failure (HF) hospitalization, and its association with 30-day outcomes. ASCEND-HF was a randomized trial of nesiritide vs. placebo in 7141 patients hospitalized with acute HF in which dyspnoea relief at 6 h was measured on a 7-point Likert scale. Patients were classified as having early dyspnoea relief if they experienced moderate or marked dyspnoea improvement at 6 h. We analysed the clinical characteristics, geographical variation, and outcomes (mortality, mortality/HF hospitalization, and mortality/hospitalization at 30 days) associated with early dyspnoea relief. Early dyspnoea relief occurred in 2984 patients (43%). In multivariable analyses, predictors of dyspnoea relief included older age and oedema on chest radiograph; higher systolic blood pressure, respiratory rate, and natriuretic peptide level; and lower serum blood urea nitrogen (BUN), sodium, and haemoglobin (model mean C index = 0.590). Dyspnoea relief varied markedly across countries, with patients enrolled from Central Europe having the lowest risk-adjusted likelihood of improvement. Early dyspnoea relief was associated with lower risk-adjusted 30-day mortality/HF hospitalization [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.68-0.96] and mortality/hospitalization (HR 0.85; 95% CI 0.74-0.99), but similar mortality. Clinical characteristics such as respiratory rate, pulmonary oedema, renal function, and natriuretic peptide levels are associated with early dyspnoea relief, and moderate or marked improvement in dyspnoea was associated with a lower risk for 30-day outcomes.

Comparing Deaths from Influenza H1N1 and Seasonal Influenza A: Main Sociodemographic and Clinical Differences between the Most Prevalent 2009 Viruses

Background. During the 2009 spring epidemic outbreak in Mexico, an important research and policy question faced was related to the differences in clinical profile and population characteristics of those affected by the new H1N1 virus compared with the seasonal virus. Methods and Findings. Data from clinical files from all influenza A deaths in Mexico between April 10 and July 13, 2009 were analyzed to describe differences in clinical and socioeconomic profile between H1N1 and non-H1N1 cases. A total of 324 influenza A mortality cases were studied of which 239 presented rt-PCR confirmation for H1N1 virus and 85 for seasonal influenza A. From the differences of means and multivariate logistic regression, it was found that H1N1 deaths occurred in younger and less educated people, and among those who engage in activities where there is increased contact with other unknown persons (OR 4.52, 95% CI 1.56–13.14). Clinical symptoms were similar except for dyspnea, headache, and chest pain that were less frequently found among H1N1 cases. Conclusions. Findings suggest that age, education, and occupation are factors that may be useful to identify risk for H1N1 among influenza cases, and also that patients with early dyspnea, headache, and chest pain are more likely to be non-H1N1 cases.

Early dyspnoea relief in acute heart failure: prevalence, association with mortality, and effect of rolofylline in the PROTECT Study

Dyspnoea and pulmonary and/or peripheral congestion are the most frequent manifestations of acute heart failure (AHF) and are important targets for therapy. We have assessed changes in dyspnoea, their relationship with mortality, and the effects of the adenosine A1 receptor antagonist rolofylline on these endpoints in patients enrolled in the PROTECT trial. PROTECT was a prospective, double-blind, placebo-controlled study assessing the effect of rolofylline in patients hospitalized for AHF with dyspnoea, fluid overload, increased plasma natriuretic peptides, and mild-to-moderate renal dysfunction. Early dyspnoea relief, prospectively defined as moderately or markedly better dyspnoea at both 24 and 48 h after the start of study drug administration, occurred in 49.8% of the patients. Early dyspnoea relief was associated with greater weight loss and with reduced mortality at Days 14 and 30 [hazard ratio (HR) 0.28, 95% confidence interval (CI): 0.15, 0.50; and 0.35, 95% CI: 0.22, 0.55, respectively]. Rolofylline administration was associated with an increase in the proportion of patients showing early dyspnoea relief (HR 1.30; 95% CI: 1.08, 1.57) and with a numerically lower mortality at 14 and 30 days, largely driven by the mortality due to HF [at 30 days, HR (95% CI, P-value): 0.65 (0.38-1.10, P= 0.107)]. Rolofylline did not reduce episodes of in-hospital worsening HF or post-discharge re-admissions, nor did it improve survival at 60 or 180 days. The present analysis from PROTECT demonstrated that more weight loss was associated with early dyspnoea relief and reduced short-term mortality.

Dyspnoea and worsening heart failure in patients with acute heart failure: results from the Pre‐RELAX‐AHF study

AimsAlthough dyspnoea is the most common cause of admission for acute heart failure (AHF), more needs to be known about its clinical course and prognostic significance.Methods and resultsThe Pre-RELAX-AHF study randomized 232 subjects with AHF to placebo or four doses of relaxin and evaluated early (6–24 h Likert scale) and persistent [change in visual analogue scale area under the curve (VAS AUC) through Day 5] dyspnoea relief. Worsening heart failure (WHF) was defined as worsening AHF signs and symptoms requiring additional therapy. Patients were followed until Day 180. Early dyspnoea relief was observed in only 25% of all patients, and VAS AUC at 5 days was 45% over baseline values in all patients (32% placebo; 50% all relaxin-treated patients). Worsening heart failure to Day 5 was observed in 16% of all patients (21% placebo; 14% relaxin). Lack of persistent dyspnoea relief and WHF were associated with a longer length of initial hospital stay and worse 60-day outcomes.ConclusionDyspnoea relief in patients admitted with AHF is often incomplete, and many may show WHF after the initial stabilization. Both lack of persistent dyspnoea relief and in-hospital WHF predict a longer length of stay and worse outcome.

Investigation and discussion on the effect of applying preventive measures for flat- lying pressure sore into cervical vertebra trauma against the occurrence of early dyspnea

目的 探讨通过减少翻身次数稳定颈椎,减少呼吸困难发生率.方法 将56例颈椎外伤早期患者随机分为实验组和对照组,实验组采取平卧位压疮预防护理,对照组行常规翻身护理.观察2组的病情变化及压疮预防效果.结果 实验组呼吸困难发生率明显低于对照组,2组压疮发生率均为零.结论 在颈椎外伤早期尽量减少翻身次数,可相对稳定病情,同时可以做好预防压疮的护理。