1. Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure.
- Author
-
Demoule, Alexandre, Baptiste, Amandine, Thille, Arnaud W., Similowski, Thomas, Ragot, Stephanie, Prat, Gwénael, Mercat, Alain, Girault, Christophe, Carteaux, Guillaume, Boulain, Thierry, Perbet, Sébastien, Decavèle, Maxens, Belin, Lisa, and Frat, Jean-Pierre
- Abstract
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 /FiO2 (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), PaO2 /FiO2 (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. [ABSTRACT FROM AUTHOR]- Published
- 2024
- Full Text
- View/download PDF