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Symptom Burden and Distress in Individuals Undergoing Noninvasive Ventilation for Acute Respiratory Failure FREE TO VIEW

Tracy Smith; Mary Dunford; Meera Agar, MBBS; Patricia Davidson, RN; Christine Jenkins, MBBS; Jane Ingham
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University of New South Wales, Sydney, NSW, Australia

Chest. 2014;146(4_MeetingAbstracts):39A. doi:10.1378/chest.1994789
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SESSION TITLE: COPD Diagnosis and Evaluation Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Patients with cardiorespiratory disease have a high symptom burden when assessed in inpatient or outpatient settings. Such patients may develop to acute exacerbations, complicated by respiratory failure. Non-invasive ventilation (NIV) is increasingly used to manage acute respiratory failure due to decompensated cardiorespiratory disease. Little is known about the distress experienced by patients undergoing NIV, including symptom burden and delirium point prevalence. To date, no studies have quantified either of these important clinical endpoints.

METHODS: Consecutive consenting, English speaking, cognitively intact patients treated outside ICU with NIV for hypercapnic respiratory failure were recruited. Assessment occurred within 36 hours of starting NIV. Symptom burden over the previous 72 hours was assessed measured using the Condensed Memorial Symptom Assessment Scale (CMSAS). This scale assesses the peak bothersomeness of 11 physical symptoms (rated 0-4) and frequency of 3 psychological symptoms (rated 0-4). Delirium point prevalence was assessed using the Confusion Assessment Method for ICU (CAM-ICU).

RESULTS: Fifty participants (64% female, mean age 71.9yrs, SD 13.1) were recruited. Prior to NIV, mean arterial pH was 7.30(SD 0.08) and a mean arterial pCO2 58.1mmHg(SD 11.9). Of these, 38% had obstructive lung disease, 14% had heart failure, 30% had both these conditions. The remainder had other causes of respiratory failure. The most prevalent symptoms were breathlessness(92%), dry mouth(88%) and lack of energy(86%). These were also the most bothersome symptoms. The most frequent psychological symptom was worry(64%). The mean total CMSAS score was 1.60(SD 0.66), with the mean physical symptom score of 1.62(SD 0.63) and the mean psychological score of 1.57(SD1.22). Four(8%) patients screened positive for delirium on the CAM-ICU.

CONCLUSIONS: Breathlessness, dry mouth and lack of energy are highly prevalent and bothersome in NIV patients. Psychological symptoms are also highly distressing. The point prevalence of delirium was 8%, however this may be an underestimate.

CLINICAL IMPLICATIONS: Understanding physical symptoms allows clinicians to target symtpom relief as a clinical priority, while simultaneously managing NIV. An understanding of psychological symptom burden requires further work to facilitate holistic, patient centred care. Further examination of delirium prevalence is required given the prognostic implications and impact it may have on both patient and family distress and co-operation with NIV.

DISCLOSURE: The following authors have nothing to disclose: Tracy Smith, Mary Dunford, Meera Agar, Patricia Davidson, Christine Jenkins, Jane Ingham

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