Respiratory Failure, Noninvasive Ventilation, and Symptom Burden: An Observational Study

• Published in: Journal of pain and symptom management Vol. 57; no. 2; pp. 282 - 289.e1
• Main Authors: Smith, Tracy A., Ingham, Jane M., Jenkins, Christine R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2019; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; APACHE; Breathlessness; Cardiorespiratory diseases; chronic obstructive; Cost of Illness; Cough reflex; Cross-Sectional Studies; Dyspnea; Female; heart failure; Hospitalization; Humans; Hypercapnia - complications; Hypercapnia - therapy; Intensive care; Male; Middle Aged; Mouth; Non-invasive; noninvasive ventilation; Noninvasive Ventilation - methods; Observational studies; Pain; Pain - etiology; Pain Measurement; palliative care; Patient admissions; Physical symptoms; Prospective Studies; Psychological distress; Psychological problems; pulmonary disease; Respiratory failure; respiratory insufficiency; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - psychology; Respiratory Mechanics; Respiratory therapy; Symptoms; Ventilation; Ventilators; heart failure; Dyspnea; pulmonary disease; noninvasive ventilation; chronic obstructive; palliative care; respiratory insufficiency
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2018.10.505

Noninvasive ventilation (NIV) is commonly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. We describe symptom burden in this population.
Fifty consecutive, consenting, English-speaking, cognitively intact patients, admitted to wards other than the intensive care unit in a tertiary teaching hospital and treated with NIV for hypercapnic respiratory failure, were recruited. The 14-item Condensed Memorial Symptom Assessment Scale was used to assess physical and psychological symptoms within 36 hours of commencing NIV. Breathlessness (using Borg score), pain location and intensity using a numerical rating scale, and four symptoms potentially prevalent in patients undergoing NIV (cough, sputum, gastric bloating, and dry eyes) were also assessed.
Patients reported a median of 10 symptoms (IQR 9–13). A median of five symptoms (IQR 3–7) were rated as severe. Breathlessness was the most prevalent and most distressing symptom, with participants reporting a mean maximum Borg score of 7.55 over the 24 hours before admission. Dry mouth, lack of energy, cough, sputum, difficulty sleeping, and psychological symptoms were prevalent. Pain, when reported, was of moderate intensity and contributed to distress.
This study describes the patient-reported symptoms occurring during an episode of acute respiratory failure. Understanding the symptom profile of patients in this setting may allow clinicians to target symptom relief while simultaneously managing respiratory failure, enhancing care.