• Romain Persichini, Frédérick Gay, Matthieu Schmidt, Julien Mayaux, Alexandre Demoule, Capucine Morélot-Panzini, and Thomas Similowski.
• From the AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France (R.P., M.S., J.M., A.D., C.M.-P., T.S.); AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Pôle Biologie Médicale et Pathologie, Service de Parasitologie et Mycologie, Paris, France (F.G.); Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (M.S., C.M.-P., T.S.); INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (M.S., C.M.-P., T.S.); Sorbonne Universités, UPMC Univ Paris 06, UMR_S 974 Equipe 1, Paris, France (A.D.); and INSERM, UMR_S 974 Equipe 1, Paris, France (A.D.).
• Anesthesiology. 2015 Oct 1;123(4):830-7.

BackgroundDyspnea, like pain, can cause major suffering in intensive care unit (ICU) patients. Its evaluation relies on self-report; hence, the risk of being overlooked when verbal communication is impaired. Observation scales incorporating respiratory and behavioral signs (respiratory distress observation scales [RDOS]) can provide surrogates of dyspnea self-report in similar clinical contexts (palliative care).MethodsThe authors prospectively studied (single center, 16-bed ICU, large university hospital) 220 communicating ICU patients (derivation cohort, 120 patients; separate validation cohort, 100 patients). Dyspnea was assessed by dyspnea visual analog scale (D-VAS) and RDOS calculated from its eight components (heart rate, respiratory rate, nonpurposeful movements, neck muscle use during inspiration, abdominal paradox, end-expiratory grunting, nasal flaring, and facial expression of fear). An iterative principal component analysis and partial least square regression process aimed at identifying an optimized D-VAS correlate (intensive care RDOS [IC-RDOS]).ResultsIn the derivation cohort, RDOS significantly correlated with D-VAS (r = 0.43; 95% CI, 0.29 to 0.58). A five-item IC-RDOS (heart rate, neck muscle use during inspiration, abdominal paradox, facial expression of fear, and supplemental oxygen) significantly better correlated with D-VAS (r = 0.61; 95% CI, 0.50 to 0.72). The median area under the receiver operating curve of IC-RDOS to predict D-VAS was 0.83 (interquartile range, 0.81 to 0.84). An IC-RDOS of 2.4 predicted D-VAS of 4 or greater with equal sensitivity and specificity (72%); an IC-RDOS of 6.3 predicted D-VAS of 4 or greater with 100% specificity. Similar results were found in the validation cohort.ConclusionsCombinations of observable signs correlate with dyspnea in communicating ICU patients. Future studies in noncommunicating patients will be needed to determine the responsiveness to therapeutic interventions and clinical usefulness.

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