Is the Content of Textbooks on the Evaluation of a Patient in Respiratory Distress Adequate?

Tulaimat, Aiman; Patel, Ashlesha; Shah, Biraj; Littleton, Stephen W.

doi:10.4187/respcare.01112

Cited by 6 publications

(2 citation statements)

References 33 publications

(15 reference statements)

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“…[8,9] Lastly, the physicians counted the respiratory rate (RR) over one or two minutes and recorded the fraction of inhaled oxygen (FIO 2 ). [8,10]…”

Section: Methodsmentioning

confidence: 99%

DiapHRaGM: A mnemonic to describe the work of breathing in patients with respiratory failure

Tulaimat

Trick

2017

PLoS ONE

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BackgroundThe assessment of the work of breathing in the definitions of respiratory failure is vague and variable.ObjectiveIdentify a parsimonious set of signs to describe the work of breathing in hypoxemic, acutely ill patients.MethodsWe examined consecutive medical ICU patients receiving oxygen with a mask, non-invasive ventilation, or T-piece. A physician inspected each patient for 10 seconds, rated the level of respiratory distress, and then examined the patient for vital signs and 17 other physical signs. We used the rating of distress as a surrogate for measuring the work of breathing, constructed three multivariate models to identify the one with the smallest number of signs and largest explained variance, and validated it with bootstrap analysis.ResultsWe performed 402 observations on 240 patients. Respiratory distress was absent in 78, mild in 157, moderate in 107, and severe in 60. Respiratory rate, hypoxia, heart rate, and frequency of most signs increased as distress increased. Respiratory rate and hypoxia explained 43% of the variance in respiratory distress. Diaphoresis, gasping, and contraction of the sternomastoid explained an additional 28%. Heart rate, blood pressure, alertness, agitation, body posture, nasal flaring, audible breathing, cyanosis, tracheal tug, retractions, paradox, scalene or abdominal muscles contraction did not increase the explained variance in respiratory distress.ConclusionMost of the variance is respiratory distress can be explained by five signs summarized by the mnemonic DiapHRaGM (diaphoresis, hypoxia, respiratory rate, gasping, accessory muscle). This set of signs may allow for efficient, standardized assessments of the work of breathing of hypoxic patients.

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“…[8,9] Lastly, the physicians counted the respiratory rate (RR) over one or two minutes and recorded the fraction of inhaled oxygen (FIO 2 ). [8,10]…”

Section: Methodsmentioning

confidence: 99%

DiapHRaGM: A mnemonic to describe the work of breathing in patients with respiratory failure

Tulaimat

Trick

2017

PLoS ONE

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“…They provide sparse information on detecting these signs and give no guidance on using them in determining the need for mechanical ventilation. 6 The definitions of respiratory distress used in clinical trials are not useful for clinicians. These definitions require continuous monitoring, describe distress when it is severe enough to require ventilator support and not lower levels, consider distress present when any of up to 10 conditions are met, and frequently include respiratory distress as one of these conditions.…”

Section: Introductionmentioning

confidence: 99%

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

et al. 2014

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BACKGROUND: When deciding whether mechanical ventilation is indicated, physicians integrate their findings on physical examination in a gestalt known as respiratory distress. Despite its importance, this gestalt is poorly understood. This study aims to describe the association between the rating of the severity of respiratory distress and vital signs, severity of illness, use of mechanical ventilation, and death. A prospective observational study with 1,134 consecutive subjects with uncertain triage evaluated by a critical care consult team was carried out in a public inner city teaching hospital. METHODS: After the initial evaluation of each patient, a critical care physician rated the level of respiratory distress. We recorded vital signs, diagnosis, and laboratory results and calculated the Acute Physiology and Chronic Health Evaluation (APACHE) II score. We recorded if mechanical ventilation was initiated by 72 h and if the subject died during the hospitalization. RESULTS: The most common diagnoses were respiratory illnesses. Higher distress levels were associated with higher breathing frequency (20, 22, 27, and 30 breaths/min, P < .001) and heart rate (96, 101, 109, and 116 beats/min, P < .001) and lower S pO 2 (97, 95, 93, and 92%, P < .001). These variables explain only a small portion of the variance of distress. Distress correlated weakly with the APACHE II score (r ‫؍‬ 0.22, P ‫؍‬ .001). Blood pressure, temperature, Glasgow coma scale score, and laboratory data were unrelated to the levels of distress. However, higher levels of distress correlated with intubation rates (5, 13, 27, and 41%, P < .001). The area under the receiver operating characteristic curve for respiratory distress predicting intubation (0.72) was larger than that for breathing frequency (0.65). Distress was an independent predictor of intubation but not of death. CONCLUSIONS: A physician's rating of respiratory distress is independently predictive of intubation in 72 h. Vital signs explain only a small proportion of variance in distress; the other observations contributing to a physician's rating of distress must be determined.

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Don't Hyperventilate Over Triage Respiratory Rates

Cooper¹,

Green

2013

Annals of Emergency Medicine

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Is the Content of Textbooks on the Evaluation of a Patient in Respiratory Distress Adequate?

Cited by 6 publications

References 33 publications

DiapHRaGM: A mnemonic to describe the work of breathing in patients with respiratory failure

DiapHRaGM: A mnemonic to describe the work of breathing in patients with respiratory failure

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

Don't Hyperventilate Over Triage Respiratory Rates

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