Respiratory Distress Observation Scale Research Articles

Effect of lung breather on hospital stay in patients with acquired pneumonia: a randomized clinical study

INTRODUCTION. Acquired pneumonia is a severe medical condition that is addressed as life-threating issue requiring intensive care. The Medical Breather device can activate and strengthen both the inspiratory and expiratory muscles, so it can be useful for patients with pneumonia. AIM. To investigate the breather effect on length of hospital stay in patients with pneumonia. MATERIALS AND METHODS. Sixty participants diagnosed with acquired pneumonia “30 women, 30 men stayed in hospital in ICU for two weeks; aged 30–40 years old” selected from chest department of Kasr Al-Aini Intensive Care Unit (ICU) at Cairo University. They were randomly allocated into equal groups; Group A received respiratory training via incentive spirometer, and traditional chest physiotherapy; and Group B received respiratory training via Breather, and traditional chest physiotherapy, both received 3 session daily/2 weeks. Diaphragmatic excursion, Respiratory Distress Observation Scale, and ICU discharge were assessed before and after the treatment. RESULTS. Both groups revealed significant improvement after the treatment, while Breather group showed a high significant increase in pH 1.23 %, PaO2 11.79 %, SaO2 6.1 %, and diaphragmatic excursion by 36.97 %, also decrease in PaCO2 2.78 %, RDOS 39.06 % and NEWS2 by 50.72 % in comparison to incentive spirometer group that recorded significant increase in pH 0.68 %, PaO2 6.69 %, SaO2 by 2.66 %, and diaphragmatic excursions by 8.15 %, also significant decrease in PaCO2 12.12 %, RDOS 15.01 % and NEWS2 by 20.93 %. HCO3 revealed no significant difference post treatment (p 0.05). DISCUSSION. Breather usage in inspiratory musculatures training (IMT) gained Maximum Inspiratory Pressure (Pimax) significant improvement. IMT enforces both diaphragm and accessory respiratory musculatures. Probably functional capabilities improvements based on enhanced respiratory musculatures’ both endurance and strength that improve pulmonary oxygen uptake thus minimize dyspnea severity. Respiratory muscles training program improves not only cognitive function. Moreover, IMT could be addressed as a prime component of respiratory training in combine with expiratory one that is why whom has preserved pulmonary function. CONCLUSION. Breather as a respiratory training technique has remarkable results in reducing hospital stays in patients with acquired pneumonia, and significant positive effects on diaphragmatic function, oxygenation levels. Therefore, it is recommended to use Breather for routine acquired pneumonia care. REGISTRATION: Clinicaltrials.gov identifier: No NCT06062862; registered April 30, 2022.

Fan Therapy for Dyspnea in Lung Transplant Recipients in the Intensive Care Unit: A Before-and-After Study.

Introduction Fan therapy has gainedattention as a non-pharmacological treatment for alleviating dyspnea in patients receiving palliative care and in those with chronic progressive diseases. However, the effectiveness of fan therapy for dyspnea in critically ill patients in intensive care units (ICUs) remains unclear. This study aimed to investigate the efficacy and safety of fan therapy for lung transplant patients in the ICU. Methods Fan therapy was performed on lung transplant recipients (age >18 years) who experienced dyspnea during their ICU stay. A tabletop portable fan was used to blow air on the patient's face for five minutes providing fan therapy. The intensity of dyspnea before and after the fan therapy was determined, and a statistical analysis was conducted using a paired t-test to evaluate the changes. Results Between May 2023 and February 2024, 16 patients who were admitted to the ICU following lung transplantation were screened, and eight patients received fan therapy. Fan therapy was performed at a median of postoperative day 12. Seven patients (87.5%) received mechanical ventilation via tracheostomy. The mean (±standard deviation) numerical rating scale (NRS) for dyspnea before and after fan therapy was 5.6±2.3 and 4.4±1.5, respectively (p= 0.08). The mean (±standard deviation) respiratory distress observation scale (RDOS) before and after fan therapy was 4.8 ± 2.0 and 3.8 ± 1.7, respectively (p= 0.03). No serious adverse events were observed, and no significant alterations were observed in the respiratory rate, oxygen saturation levels, pulse rate, or blood pressure. Conclusion The findings suggest that fan therapy can be safely used to relieve dyspnea in lung transplant recipients during their ICU stay. Further evaluations in larger trials are required to confirm the results of this study.

Addressing Disparities Between Physician Rated and Self-Reported Dyspnea Using Machine Learning

Nearly 50% of intensive care and 25% of tertiary care patients experience dyspnea, or the sensation of unsatisfied breathing. Dyspnea decreases quality of life, impacts clinical outcomes, and can have long standing psychological consequences for some patients. Current methods of identifying dyspnea severity (such as the respiratory distress observation scale or RDOS) lack suffcient quantifiable measurements of dyspnea to accurately predict its severity. In our testing, while the RDOS does have predictive power, it frequently produces underestimates compared to self-reported dyspnea severity (r = 0.32; p = 0.0081). Furthermore, dyspnea severity can change throughout the day, requiring healthcare professionals to conduct RDOS evaluations multiple times to attempt to meet patient needs. Therefore, there is an urgent need for continuous, accurate monitoring of dyspnea severity in the hospital setting. To address this need, we are using non-invasive data collected during induced bouts of dyspnea to train a machine learning (ML) algorithm in dyspnea prediction. We employ a steady-state end-tidal forcing breathing system and adjust end-tidal gas tensions manually while collecting PO­­­­2, PCO2, SpO2, and ventilation data. Preliminary findings show several physiological and demographic factors independently correlate to dyspnea severity, including BMI (r = 0.49; p = 0.007), end-tidal PCO­­2 (r = 0.33; p = 0.008), and inspired PO2 (r = -0.25; p = 0.043). We achieved an accuracy of 84%, 83.3%, and 82% in-dataset predictions using k-nearest neighbor, random forest, and logistic regression approaches respectively. Several physiological biomarkers and demographic factors were used as inputs and self-reported dyspnea was used as the predicted output. These findings show promise for the use of ML in dyspnea prediction. With further testing and use of a broader participant population, it may be possible to use ML models such as these to improve patient outcomes and overall quality of life. University of California, Riverside. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effect of Dexmedetomidine for Palliative Sedation for Refractory Dyspnoea in Patients with Terminal-Stage Cancer.

Dyspnoea affects a considerable percentage of patients with terminal-stage cancer, and clinical guidelines recommend palliative sedation for patients with refractory dyspnoea. Midazolam is currently the most commonly used sedative; however, it can cause serious adverse reactions, such as respiratory/circulatory depression. Hence, there is a need for an alternative sedative. Dexmedetomidine (DEX) is a promising alternative as its "awake sedation" effect; however, little is known regarding its use in patients with end-stage dyspnoea. Therefore, the aim of this study was to determine the safety and usefulness of DEX for palliative sedation of patients with refractory dyspnoea. This retrospective study included patients with terminal-stage cancer who received DEX for palliative sedation owing to refractory dyspnoea in the hospice ward from January 2018 to October 2022. We analysed their general data, dyspnoea conditions, sedation details, sedative treatment effect, dyspnoea relief, and changes in vital signs before and after sedation, via paired t-tests. We included 17 patients with terminal-stage cancer who received DEX palliative sedation at a dose of 0.2-0.9 µg/kg·h for refractory dyspnoea, among whom 6 (35%) received a loading dose of 1 µg/kg in 10 min. After 1 h of sedation and at the maximum sedation dose, the Respiratory Distress Observation Scale and Richmond Agitation-Sedation Scale scores decreased significantly compared with those before sedation (all P<0.001), as did the respiratory rate (P=0.024 and P=0.008, respectively). The heart rate and blood oxygen saturation did not significantly change, whereas the systolic and diastolic blood pressure after 1 h of sedation were significantly lower than those before sedation (both P=0.015). DEX is a promising palliative sedative for patients with terminal-stage cancer, as it safely relieved the symptoms of refractory dyspnoea without inducing serious adverse reactions. Therefore, DEX may greatly enhance the quality of life for patients with terminal-stage cancer.

Prognostic Value of the Intensive Care Respiratory Distress Observation Scale on ICU Admission.

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. 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. 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. IC-RDOS, an observational correlate of dyspnea, but not dyspnea itself, was associated with higher mortality in ICU subjects.

Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units.

BackgroundIncorrect adjustment of the respiratory parameters of the mechanical ventilator increases respiratory distress and work of breathing (WOB) in mechanically ventilated patients. The accurate adjustment of pressure support increases thepatient's comfort and decreases respiratory distress and WOB, etc.; thus, the present study was conducted to compare the effects of two pressure support adjustment methods on respiratory distress in patients under mechanical ventilation to investigate whether the rapid shallow breathing index (RSBI)method can reduce patients’ respiratory distress more and faster than the tidal volume (VT) and respiratory rate (RR) methods.Patients and methodsThe study was conducted in 2020 on 56 mechanically ventilated patients with respiratory distress. The patients’ respiratory distress was first measured using RSBI and the respiratory distress observation scale (RDOS). The pressuresupport was then adjusted in the patients according to the RSBI (in the trial group, n = 33)and VT and RR (in the control group, n = 23). The patients’ respiratory distress was measured again in both groups 15 and 30 minutes after the pressure support adjustment.ResultsThe results showed no significant differences between the two groups in the mean RSBI and RDOS before (p = 0.374, p = 0.657 respectively) and 30 (p = 0.103, p = 0.218 respectively) minutes after the adjustment of the pressure support, but these mean values differed significantly (p = 0.025 for RSBI and p = 0.044 for RDOS) between the groups 15 minutes after the adjustment. Moreover, the interaction effect of the group * time for RDOS has become significant nonlinearly (p = 0.037), but none of the interaction effects of the group * time were significant for RSBI (linear: p = 0.531; nonlinear: p = 0.272).ConclusionThese two methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods.How to cite this articleBarati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(9):1026–1030.Key messageVT, RR, and RSBI methods finally reduced the patients’ respiratory distress almost equally, but RSBI method can relieve the patients’ respiratory distress faster than the VT and RR methods.

Translation, reliability, and validity of Japanese version of the Respiratory Distress Observation Scale.

Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases and is defined as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity." However, Japanese intensive care units (ICUs) do not routinely screen for dyspnea, as no validated Japanese version of the Respiratory Distress Observation Scale (RDOS) is available. Therefore, we aimed to translate the English version of this questionnaire into Japanese and assess its validity and reliability. To translate the RDOS, we conducted a prospective observational study in a 12-bed ICU of a universal hospital that included 42 healthcare professionals, 10 expert panels, and 128 ventilated patients. The English version was translated into Japanese, and several cross-sectional web-based questionnaires were administered to the healthcare professionals. After completing the translation process, a validity and reliability evaluation was performed in the ventilated patients. Inter-rater reliability was evaluated using Cohen's weighted kappa coefficient. Criterion validity was ascertained based on the correlation between RDOS and the dyspnea visual analog scale. The area under the receiver operating characteristic curve analysis was used to evaluate the ability of the RDOS to identify patients with self-reported dyspnea. The average content validity index at the scale level was 0.95. Data from the 128 patients were collected and analyzed. Cohen's weighted kappa coefficient and the correlation coefficient between the two scales were 0.76 and 0.443 (95% confidence intervals 0.70-0.82 and 0.23-0.62), respectively. For predicting self-reported dyspnea, the area under the receiver operating characteristic curve was 0.81 (95% confidence interval 0.67-0.97). The optimal cutoff used was 1, with a sensitivity and specificity of 0.89 and 0.61, respectively. Our findings indicated that the Japanese version of the RDOS is acceptable for face validity, understandability, criterion validity, and inter-rater reliability in lightly sedated mechanically ventilated patients, indicating its clinical utility.

Respiratory Distress in Hospitalized Non-Mechanically Ventilated COVID-19 Adults: A Retrospective Multicenter Cohort Study.

Background:COVID-19 typically presents with respiratory symptoms which may progress with severe disease. There are standard guidelines for managing respiratory distress (e.g. opioids, anxiolytics) and palliative care teams are well versed in managing these symptoms.Aim:Determine the extent to which hospitalized COVID-19 patients with moderate respiratory distress received medications or palliative consultation for symptom management and if these interventions had any association with outcomes.Design:Retrospective chart review for hospitalized COVID-19+ patients from March 2-April 30, 2020.Setting:Large integrated health system in the New York Metropolitan area.Patients:312 adult patients hospitalized with COVID-19 with an order for a non-rebreather mask and meeting criteria for moderate respiratory distress on the Respiratory Distress Observation Scale: concurrent respiratory rate ≥30 and heart rate ≥110 at any point during hospitalization. Patients receiving mechanical ventilation or intensive care were excluded.Results:Most COVID-19 patients experiencing moderate respiratory distress did not receive medications or palliative consultation for symptom management. Patients who received medications were predominantly white, older, and had a Do-Not-Resuscitate order. Patients who received a palliative consultation were more likely to be older, female, and white, with a Do-Not-Resuscitate order. Mortality was similar between those receiving medication and those who did not.Conclusion:Medications and palliative expertise for symptom management were underused for patients with moderate respiratory distress due to COVID-19. Education and triggers may help providers to identify moderate respiratory distress and consider symptomatic treatment and palliative consultation when appropriate.

Respiratory Distress Observation Scale Italian Version: Cultural-Linguistic Validation and Psychometric Properties.

Dyspnea can be assessed using self-rating scales but, as death approaches, self-reporting becomes difficult. The validated Respiratory Distress Observation Scale measures dyspnea distress. The aim of this study was to develop the Italian version of the Respiratory Distress Observation Scale and to examine its psychometric properties. This was a cross-sectional study, analyzing cultural and linguistic validation, content validity, and psychometric properties. Eighty-nine palliative care subjects were enrolled to validate the Italian version of the Respiratory Distress Observation Scale. Patients had an average age of 74.5 (SD, 11.6) years, and 52% (n = 46) were female. Fourteen experts in palliative care evaluated the Italian Respiratory Distress Observation Scale in terms of the content validity ratio and the content validity index (CVI). The Italian Respiratory Distress Observation Scale was reported with an internal consistency (Cronbach α value) of .72 and an overall substantial interrater reliability (Cohen κ method). The Italian Respiratory Distress Observation Scale achieved a scale-level CVI of 93%, an items-level CVI of greater than 86%, and a minimum content validity ratio value of 0.71. A weak positive correlation was found between the Respiratory Distress Observation Scale and the Dyspnea Visual Analog Scale scores (0.374; P < .001). The Italian Respiratory Distress Observation Scale showed good reliability and validity for patients in palliative care. The Respiratory Distress Observation Scale measured respiratory distress in patients nearest to death.

Assessment of dyspnoea in Covid 19 patients using modified Borg scale

Background: Dyspnoea (shortness of breath) is a common excruciating symptom. Shortness of breath is a feeling associated with impaired respiratory function. As difficulty breathing, I can not breathe. It occurs in 64 % in Covid 19 patients. Objective: Our goal is to evaluate dyspnoea using Borg scale that assesses the functional state of respiratory function. Material–methods: We assessed (92) Covid 19 patients with a categorical ten-point rating, a corresponding verbal description (Table 1). Patients were aged between 44–78 years old. Fifty of them (50) were obese, body weight &gt;greater than 90 kg with comorbidities (hypertension and diabetes mellitus). The assessment was performed by a specialist anaesthesiologist (pain clinic) on the Borg scale. Results: (12) Covid 19 patients with moderate dyspnoea. (30) Covid 19 patients with severe dyspnoea (hard). (46) Covid 19 patients very severe dyspnoea (really hard). (4) Covid 19 patients maximum intolerable dyspnoea (maximum). We immediately intubated them. There’s not internationally accepted way to assess shortness of breath. Scales are commonly used to assess respiratory difficulty (for example: respiratory distress observation scale). Conclusions: The Borg scale has been used successfully in Covid 19 patients. Every patient experiences dyspnoea differently, depending on the severity of the disease. However, it seems that the assessment of dyspnoea on the Borg scale, taking into account co-factors leads to safer monitoring of severely ill Covid 19 patients.

Exploration and Development of a Simpler Respiratory Distress Observation Scale (modRDOS-4) as a Dyspnea Screening Tool: A Prospective Bedside Study

Introduction: End-of-life patients face difficulties in reporting respiratory distress. The Respiratory Distress Observation Scale (RDOS) is a well-known tool; however, field implementation has been challenging from ground feedback. We sought to develop a simpler scale.Setting: Patients referred for palliative consult in a tertiary hospital in Singapore were recruited.Methods: A priori, we identified 18 dyspnea physical signs and documented their presence through bedside observation. Dyspnea severity was self-reported. The cohort was randomly split into training and test sets. Partial least square regression with leave-one-out cross-validation was used to develop a four-point model from the training set. Using the test set, data fit was compared using Akaike and Bayesian Information Criterion. Discrimination was assessed using receiver operating characteristics.Results: Of 122 patients, mean age was 67.9 years (range 23–93, standard deviation 12.9), 71.3% had a primary cancer diagnosis, and 58.1% were chair/bedbound with a Palliative Performance Scale of ≤50. Median reported dyspnea scale was 5 (interquartile range 3–7). Our model (modRDOS-4) consisted of four predictors (grunting, respiratory rate, accessory muscle use, paradoxical breathing). A modRDOS-4 of ≥6 identified moderate-to-severe dyspnea with a sensitivity of 0.78 and specificity of 0.90. Using the test set, with the modRDOS-4, the Akaike Information Criterion (AIC) is 149.8, Bayesian Information Criteria (BIC) is 154.1, and the receiver operating characteristics (ROC) is 0.74. With the original RDOS, the AIC is 145.2, BIC is 149.5, and ROC is 0.76.Conclusion: For a quick assessment of dyspnea, we developed a four-item tool with a pilot web-based nomogram. External validation is needed.

Breathing discomfort evaluation and nursing practices effect on mechanically ventilated patients to improve weaning outcomes

AbstractBackground: Breathing discomfort is one of the worst experienced symptoms by the mechanically ventilated patients in ICUs Aim: to evaluate the effect of implemented nursing care on breathing discomfort and weaning outcomes for patients undergoing mechanical ventilation. Design: A quasi-experimental research design. Setting: General intensive care unit at Assuit university hospital. Patients and methods: Convenient sample of 80 patients(40 patients for study group and 40 patient for control group) who were mechanically ventilated for >24 hrs. Breathing discomfort was evaluated according to patient conscious level and nursing care was done for study group and routine care for control group. Tools : Four tools were used for data collection in the study; Patient assessment, breathing discomfort evaluation: Part I :Respiratory distress observation scale(RDOS) and Part II: Dyspnea Visual Analogue Scale(D-VAS), Patient outcomes assessment and nursing intervention tool Results: High statistical significant difference between study group and control group in relation to arterial blood gases and haemodynamic parameters after intervention. Concerning weaning outcomes; 57% of control group experienced weaning failure versus 35% in study group Conclusion: Implementing nursing care among the mechanically ventilated patients were effective in improving patient outcomes. Recommendations: Apply nursing care for breathing discomfort as a routine care in ICUs.

Cross-cultural adaptation and psychometric testing of a Chinese version of respiratory distress observation scale

Cross-cultural adaptation and psychometric testing of a Chinese version of respiratory distress observation scale

Effectiveness of Incentive Spirometry on Respiratory Parameters among Patients with Chest Tube Drainage in Icus of a Tertiary Care Hospital, Ludhiana, Punjab

The respiratory system plays a crucial role in delivering oxygen to the cells of our body. The cells of ourbody require a continuous supply of oxygen, without this oxygen we would die within minutes. All of thisbreathing couldn’t happen without help from the respiratory system. The aim of the study was to assess theeffectiveness of Incentive Spirometry on respiratory parameters among patients with Chest Tube drainage.A pre-experimental one group pre-test and post-test design was carried out by using purposive samplingtechnique and it was conducted on 30 patients with chest tube drainage in ICUs of a tertiary care hospital,Ludhiana, Punjab. Data was collected by self-report for demographic variables, clinical profile sheet andassessed the respiratory parameters by using Respiratory Distress Observation Scale (DOS). The Mean±SD ofheart rate in pre-test (O1) was 1.43±0.50 which got decreased to 0.36±0.49 in post- test (O4) with statisticallysignificant at p = 0.000. In pre-test Mean±SD of respiratory rate was 1.30±0.46 and got decreased to 0.30± 0.46 during post- test. The Mean±SD of restlessness was 1.23±0.81 in pre-test whereas in post-test it wasdecreased to 0.23±0.43. The study conclude that Almost all subjects were having respiratory distress duringpre-test but after using incentive spirometry in chest tube drainage patients, the parameters were improveddaily gradually and during post-test only 26.6% patients were having respiratory distress. The results werehighly significant at p&lt;0.05. The incentive spirometry is effective for improving respiratory parametersamong chest tube drainage patients.

Development and Content Validity of a Respiratory Distress Observation Scale-Infant.

Background: Respiratory distress is one of the most commonly reported symptoms in infants in the neonatal intensive care unit and can lead to substantial morbidity and mortality if not assessed and managed appropriately. Yet, a validated scale for assessing respiratory distress across clinicians in infants is not available. Furthermore, a valid and reliable scale is needed as a dependent measure in studies about infant respiratory distress. Objective: The purpose of this study was to establish a content validity index (CVI) of a modification of the Respiratory Distress Observation Scale© (RDOS) for use with infants who are at least 37 weeks gestational age. Design: The RDOS© was revised using the respiratory characteristics of infants and offered to clinical experts for review. Setting/Subjects: A pool of nine experts in neonatal care, including two neonatologists, two nurse practitioners, one respiratory therapist, two staff nurses, and two nurse scientists, evaluated the revised scale for content validity. Results: The scale CVI was calculated by averaging the item CVIs that were ≥0.80 yielding a scale CVI = 0.96. Our content experts further recommended adding the variable capillary perfusion. Conclusions: Content validity was established. This RDOS-Infant has clinical and research utility if subsequent psychometric testing yields additional acceptable reliability and validity statistics.

Validity, Reliability, and Diagnostic Accuracy of the Respiratory Distress Observation Scale for Assessment of Dyspnea in Adult Palliative Care Patients

BackgroundThe prevalence and severity of dyspnea increase at the end of life. Many of these patients have difficulty in reporting their symptoms. Accurate surrogate measures are needed for appropriate assessment and treatment. The Respiratory Distress Observation Scale (RDOS) is proposed as a possible scale although more external validation is needed. We set out to validate the RDOS in the context of palliative care patients near the end of life. MeasuresWe prospectively studied 122 palliative care patients in a tertiary hospital in Singapore. Prior RDOS training was done using a standardized instructional video. Dyspnea was assessed by RDOS, Dyspnea Numerical Rating Scale, and Dyspnea Categorical Scale. Pain was assessed by Pain Numerical Rating Scale. We measured RDOS inter-rater reliability, convergent validity, and divergent validity. We used area under receiver operating characteristics curve (AUC) analysis to examine the discriminant properties of RDOS using dyspnea self-report as benchmark. ResultsRDOS had good inter-rater reliability with an intraclass correlation of 0.947 (95% CI 0.919–0.976). It showed moderate-to-strong correlation with Dyspnea Numerical Rating Scale (r = 0.702) and Dyspnea Categorical Scale (r = 0.677) and negligible correlation to Pain Numerical Rating Scale (r = 0.080). It showed good discriminant properties of identifying patients with moderate and severe dyspnea with an AUC of 0.874 (95% CI 0.812–0.936). RDOS ≥ 4 predicted patients with moderate and severe dyspnea with a sensitivity of 76.6%, specificity of 86.2%, positive predictive value of 86.0%, and negative predictive value of 76.9%. ConclusionsThe RDOS shows promise and clinical utility as an observational dyspnea assessment tool. Further studies in uncommunicative patients are needed to determine clinical usefulness and generalizability of results.

Psychometric Evaluation of the Chinese Respiratory Distress Observation Scale on Critically Ill Patients With Cardiopulmonary Diseases.

Respiratory distress is a common and distressing experience that strikes most critically ill patients with cardiopulmonary diseases. Now, most dyspnea assessment tools rely on patient's self-report. Only one instrument, the Respiratory Distress Observation Scale (RDOS), is valid for assessing respiratory distress when the patient cannot provide a dyspnea self-report. The aims of this study were to develop the Chinese version of RDOS through two-way translation and examine its reliability and validity. The first step was the translation and back-translation to establish the Chinese RDOS and examine the semantic equivalence between the back-translation version and the original one. The second step was the psychometric testing of the Chinese RDOS including internal reliability, interrater reliability, concurrent validity, convergent validity, and content and construct validity. The Chinese RDOS was reported with an internal consistency (Cronbach's α value) of .73, an interobserver reliability of .97, and a content validity index of .97. In the conscious critically ill patients, significant correlations were found between the Chinese RDOS and Spielberger State Anxiety Inventory scores or Dyspnea Vertical Visual Analog Scale scores (r = .69 and r = .76, respectively; p < .001). In the unconscious critically ill patients, there was a significantly positive correlation between the Chinese RDOS scores and fraction of inspiration O2 (r = .26, p < .05) and a significantly negative correlation between the Chinese RDOS scores and saturation peripheral oxygen (SpO2; r = -.42, p = .001). In addition, it also could effectively identify the dyspnea differences between the first and last days in the intensive care units (p < .001). The Chinese RDOS showed good reliability and validity in conscious critically ill patients. The assessment with the Chinese RDOS could be completed within a short period no matter whether the assessor has nursing background in respiratory care or not. It could help the professionals systematically manage and track the change of respiratory distress in patients.

Using a Dyspnea Assessment Tool to Improve Care at the End of Life.

Dyspnea is experienced by 15% to 70% of patients at end of life. Because of cognitive changes before death, patients may be unable to self-report dyspnea, which requires nurses to accurately assess and initiate symptom management. This study compared practicing nurses' experiential practice in the assessment and management of dyspnea in patients unable to self-report to practice using of the Respiratory Distress Observation Scale (RDOS). This pre-experimental pretest/posttest study evaluated nurse outcomes following a structured educational program aimed at preparing them to use the RDOS. Nurses (n = 39) who provide end-of-life care were recruited for the study. After receiving the educational program, there was not a significant difference in the nurse's ability to assess the patient's overall level of perceived comfort and determine a differential diagnosis. There was, however, improvement in the nurse's ability to correctly determine a patient's level of dyspnea (P = .021) and also in their ability to select appropriate treatment options. This study demonstrates applicability of the RDOS to the end-of-life population replacing experiential practice with an evidence-based tool for the assessment and treatment of dyspnea in patients who cannot self-report.

Trajectory of Dyspnea and Respiratory Distress among Patients in the Last Month of Life.

The trajectory of dyspnea has been reported among patients approaching the end of life. However, patients near death have been dropped from longitudinal studies or excluded altogether because of an inability to self-report; proxy estimates have been reported. It is not known whether dyspnea or respiratory distress remains stable, escalates, or abates as patients reach last days. Determine trajectory of dyspnea (self-reported) and respiratory distress (observed) among patients who were approaching death. A prospective, repeated-measures study of dyspnea/respiratory distress among a sample of hospice patients was done. Measures were collected at each patient encounter from hospice enrollment until patient death. Dyspnea was measured in response to "Are you short of breath?" and using the numeric rating scale anchored at 0 and 10. Nurses measured respiratory distress with the Respiratory Distress Observation Scale (RDOS). Patient consciousness (Reaction Level Scale), nearness to death (Palliative Performance Scale), diagnoses, and demographics were recorded. Data for the 30-day interval before death were analyzed. The sample was 91 patients who were female (58%) and Caucasian (83%) with dementia (32%), heart failure (26%), and cancer (13%). RDOS increased significantly from mild distress 30 days before death to moderate/severe distress on the day of death (F = 10.8, p < 0.0001). Distress was strongly correlated with nearness to death (r = -0.97, p < 0.0001) and consciousness (r = 0.97, p < 0.0001). Respiratory distress escalated in the last days. Inability to self-report raises care concerns about under-recognition and under-treatment of respiratory distress.

Improving comfort in people with dementia and pneumonia: a cluster randomized trial.

BackgroundPneumonia in people with dementia has been associated with severe discomfort. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia.MethodsA single-blind, multicenter, cluster randomized controlled trial was conducted in 32 Dutch nursing homes. Outcomes were assessed on the patient level. The main outcome measures were discomfort and symptoms: discomfort (DS-DAT: Discomfort Scale-Dementia of Alzheimer Type), (lack of) comfort (EOLD-CAD: End Of Life in Dementia-Comfort Assessment in Dying), pain (PAINAD: Pain Assessment in Advanced Dementia), and respiratory distress (RDOS: Respiratory Distress Observation Scale). Outcomes were scheduled daily from diagnosis until 10 days later and a final time between 13–15 days from diagnosis by trained observers who were blinded to the intervention and the residents’ condition and treatment. In a pre-intervention phase, usual care was provided to all homes. In the intervention phase, matched clusters of homes were randomized to either the control (n = 16) or intervention condition (n = 16).ResultsBetween 1 January 2012 and 1 May 2015, 464 episodes of pneumonia were included. Outcomes were obtained for 399 episodes in 367 residents. Longitudinal multilevel linear regression analyses were performed on log-transformed outcomes, so coefficients should be interpreted as a ratio, and a coefficient of 1 means no difference. The practice guideline in the intervention phase did not reduce the level of discomfort and symptoms: DS-DAT: 1.11 (95 % CI 0.93–1.31), EOLD-CAD: 1.01 (95 % CI 0.98–1.05), PAINAD: 1.04 (95 % CI 0.93–1.15), RDOS: 1.11 (95 % CI 0.90–1.24). However, in both the intervention and control groups, lack of comfort and respiratory distress gradually decreased during the entire 3.5 years of data collection, and were lower in the intervention phase compared to the pre-intervention phase: DS-DAT: 0.93 (95 % CI 0.85–1.01), EOLD-CAD: 0.98 (95 % CI 0.97–1.00), PAINAD: 0.96 (95 % CI 0.91–1.01), RDOS: 0.92 (95 % CI 0.87–0.98).ConclusionsWhen compared to usual care, the practice guideline for optimal symptom relief did not relieve discomfort and symptoms in nursing home residents with dementia and pneumonia. However, discomfort and symptoms decreased gradually throughout the data collection in both the intervention homes and the control homes. An intervention that focuses on creating awareness may be more effective than a physician practice guideline.Trial registrationThe Netherlands National Trial Register (ID number NTR5071. Registered 10 March 2015).Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0663-x) contains supplementary material, which is available to authorized users.