This article is more than 5 years old. Information may no longer be current.

Patients report more breathlessness after SBT compared with physicians

Nurses and physicians underestimated patient-reported scores of breathlessness, security and respiratory function during spontaneous breathing trials, according to study results.

Hege S. Haugdahl, of Nord Trøndelag University College in Norway, and colleagues conducted a prospective, multicenter, observational study to analyze experiences of breathlessness during spontaneous breathing trials in patients undergoing mechanical ventilation.

The analysis included 100 patients from three Norwegian ICUs from September 2012 to September 2014.

Patients rated breathlessness, sense of security and improvement of respiratory function using an 11-point numerical rating scale (NRS). Patients responded to questions asking if they had a sensation of breathlessness as well as if they felt secure during the spontaneous breathing trial (SBT).

Nurses and physicians treating the patients also responded to the same questions as to how they perceived the result in patients.

Sixty-two percent of patients reported moderate or severe breathlessness — defined as an NRS score of four or more. Patients self-reported breathlessness at a higher median intensity (5) than both nurses and physicians (2 for both) (P < .001).

Fifty-four percent of nurses and 48% of physicians underestimated breathlessness compared with the patients’ self-reports.

Patients also had differing reports of feeling secure (P = .005) and improvement of respiratory function (P < .001) than nurses and physicians.

Underestimation of breathlessness did not correlate with the number of years nurses or physicians worked in an ICU, according to the researchers.  

“Our findings are supported by a systemic review, which found that length of professional experience is often unrelated and even negatively related to performance measures and outcomes,” the researchers wrote. “Perhaps as for other competencies there is a level of competency that is reached after reaching a defined volume of patient interactions. Furthermore, both nurses and physicians assessments did not appropriately reflect the patients experience.”

The results indicate patients’ self-report of breathlessness should somehow be included in the evaluation of a SBT.

“Effective symptom control is based on systematic assessment, and ideally, symptoms are reported and rated by patients themselves,” the researchers wrote. – by Ryan McDonald

Disclosure: The research was supported by a grant from the Norwegian Nurses Organization.