A Dyspnea Evaluation Protocol for Respiratory therapists: A Feasibility Study

Abstract

We tested the feasibility of incorporating a dyspnea evaluation protocol into bedside assessments routinely performed by respiratory therapists (RTs) on mechanically ventilated patients at a university teaching hospital. METHODS: A dyspnea assessment protocol was incorporated into the RT assessments performed at 4-hour intervals on endotracheally intubated, mechanically ventilated patients in our medical and surgical intensive care units. RTs were asked to inquire of all responsive patients: "Are you feeling short of breath right now?" and, if yes, "Is your shortness of breath mild, moderate, or severe?" We analyzed 324 consecutive patient ventilator flow sheets from 77 medical and 161 surgical intensive care unit patients. RESULTS: Dyspnea scores were recorded during 1,870 of 2,539 scheduled RT patient assessments. The protocol compliance rate was 74%. Patients were sufficiently responsive to answer the protocol questions during 32.1% of the bedside assessments. Dyspnea was recorded in 11% (67/600) of those encounters. Dyspnea was described most often as mild. CONCLUSIONS: Initial implementation of a dyspnea evaluation protocol was moderately successful in prompting RTs to ask mechanically ventilated patients whether they felt short of breath during scheduled bedside visits. A rapid bedside evaluation for dyspnea may prove useful in evaluating the effect on patient distress of implementing protocols designed to optimize ventilator settings or the use of sedating drugs during mechanical ventilation. By this approach RTs may also be able to promote a patient-centered approach to managing respiratory failure in the intensive care unit.