Dissertations / Theses: 'Dyspnoi'

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Balen, Frédéric. "Evaluation précoce de la dyspnée aiguë de l'adulte en médecine d'urgence." Electronic Thesis or Diss., Université de Toulouse (2023-....), 2024. http://www.theses.fr/2024TLSES060.

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La dyspnée aiguë est un symptôme subjectif perçu par le patient comme une "sensation de gêne respiratoire" évoluant depuis moins de deux semaines. La dyspnée est un symptôme de défaillance du système cardio-respiratoire. Le champ des diagnostics à envisager est vaste. Les pathologies les plus graves et fréquentes en médecine d'urgence sont la pneumopathie bactérienne (18 à 25%), l'insuffisance cardiaque aiguë (18 à 24 %), l'exacerbation de Bronchopneumopathie Chronique obstructive (BPCO) (16 à 18 %), l'asthme aigu (10 à 11 %) et l'embolie pulmonaire (1 %). La dyspnée un motif de recours important à bien des égards pour la Médecine d'Urgence dans tous ses aspects (en régulation téléphonique et lors de sa prise en charge extra et intra-hospitalière). En effet, il s'agit d'un motif fréquent de recours aux urgences extra et intra-hospitalières, la démarche diagnostique est complexe et source d'erreurs et sa mortalité intra-hospitalière est élevée (5 à 15 %). Les objectifs de ce travail sont d'identifier les patients les plus sévères dès l'appel aux secours, puis identifier les patients à risque de traitement inapproprié du diagnostic de leur dyspnée et proposer des outils afin de réduire ce taux de traitements inappropriés. Afin d'identifier les patients les plus graves dès l'appel téléphonique, nous avons constitué une cohorte rétrospective de 1387 patients âgés de plus de 15 ans ayant contacté les secours (appel au SAMU) pour dyspnée du 1er juillet 2019 au 31 décembre 2019 et ayant été admis aux urgences ou décédés avant leur admission. Deux cent huit (15 %) nécessitaient la mise en place d'un support respiratoire précoce. Les facteurs prédictifs d'un recours à un support respiratoire précoce identifiables à l'appel étaient : avoir un traitement de fond par ß2-mimétique, la polypnée, une incapacité à finir ses phrases, la cyanose, les sueurs et les troubles de la vigilance. Il semble pertinent de rechercher ses éléments en régulation médicale afin d'adapter les moyens de secours à engager. Afin d'identifier les patients a risque de traitement inapproprié du diagnostic de leur dyspnée, nous avons constitué une cohorte rétrospective de 2123 patients âgés de plus de 15 ans admis en service d'urgence pour dyspnée du 1er juillet 2019 au 31 décembre 2019. Huit cent neuf (38 %) avaient un traitement inapproprié au diagnostic final de leur dyspnée, comparé aux traitements recommandés internationalement. Les facteurs de risque de traitement inapproprié étaient : un âge de plus de 75 ans, des antécédents cardiaque ou respiratoires, une SpO2 < 90 %, une auscultation pulmonaire retrouvant des crépitants bilatéraux, un foyer de crépitants ou des sibilants. Cette population doit faire l'objet d'études ultérieures afin de diminuer le taux de traitements inappropriés. Nous avons également étudié les performances diagnostique de l'échographie pleuropulmonaire (EPP) dans le diagnostic précoce de patients âgés (plus de 65 ans) admis en service d'urgence pour dyspnée. La cohorte, prospective, était composée de 116 patients. Les performances de l'EPP, disponible immédiatement au lit du patient, étaient comparables à la stratégie habituelle (comportant examen clinique et résultats biologiques) disponible à 2 heures, pour le diagnostic d'insuffisance cardiaque et de pneumopathie. L'utilisation de l'EPP devrait permettre d'approcher le diagnostic final de façon précoce et peut être diminuer le traitement inapproprié. Nous proposons un protocole de recherche à venir sur cette thématique. La dyspnée représente un défi de prise en charge pour la Médecine d'Urgence. Les travaux menés et à venir devraient nous permettre d'optimiser les prises en charge pré et intra-hospitalières Acute dyspnea is a subjective symptom perceived by the patient as a "sensation of respiratory discomfort" that has been evolving for less than two weeks. Dyspnea is a symptom of cardiorespiratory failure. The range of diagnoses to be considered is vast. The most serious pathologies frequently encountered in emergency medicine are bacterial pneumoniae (18 to 25%), acute heart failure (18 to 24%), exacerbation of Chronic Obstructive Pulmonary Disease (COPD) (16 to 18%), acute asthma (10 to 11%) and pulmonary embolism (1%). Dyspnea is an important symptom for emergency medicine, in all its aspects (telephone regulation and out-of-hospital and in-hospital management). In fact, it is a frequent reason for referral to out-of-hospital and in-hospital emergency services, the diagnostic process is complex and error-prone, and in-hospital mortality is high (5 to 15%). The objectives of this study are to identify the most severe patients as soon as they call for help, then to identify patients at risk of inappropriate treatment for the diagnosis of their dyspnea, and to propose tools to reduce the rate of inappropriate treatment. In order to identify the most severe patients from the time of the telephone call, we set up a retrospective cohort of 1387 patients aged over 15 years who contacted emergency services (call to the "112"/"911") for dyspnea from July 1, 2019 to December 31, 2019 and were admitted to the emergency department or died before admission. Two hundred and eight (15%) required early respiratory support. Factors predictive of the need for early respiratory support that could be identified on call were: having background ß2-mimetic therapy, polypnoea, inability to speak, cyanosis, sweating and altered consciousness. It seems relevant to investigate these elements during first call for help, in order to adapt the rescue resources to be engaged. In order to identify patients at risk of inappropriate treatment for the diagnosis of their dyspnea, we set up a retrospective cohort of 2123 patients aged over 15 admitted to an emergency department for dyspnea from July 1, 2019 to December 31, 2019. Eight hundred and nine (38%) had inappropriate treatment of the final diagnosis of their dyspnea, compared with internationally recommended treatments. Risk factors for inappropriate treatment were: age over 75, cardiac or respiratory history, SpO2 < 90%, pulmonary auscultation finding bilateral crackles, a crackle focus or wheezing. This population should be the subject of further studies to reduce the rate of inappropriate treatment. We also studied the diagnostic performance of lung ultrasound (LUS) in the early diagnosis of elderly patients (over 65) admitted to the emergency department for dyspnea. The prospective cohort recruited 116 patients. The performance of LUS, available immediately at the patient's bedside, was comparable to the usual strategy (including clinical examination and laboratory results) available at 2 hours, for the diagnosis of heart failure and pneumopathy. The use of LUS should make it possible to approach the final diagnosis at an early stage, and perhaps reduce inappropriate treatment. We propose a future research protocol on this topic. Dyspnea represents an important challenge for emergency medicine. Our current and future work should enable us to optimize pre-hospital and in-hospital management

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Decavèle, Maxens César. "Caractérisation de la réponse émotionnelle à la dyspnée : des corrélats observationnels physio-cliniques à la reconnaissance des expressions faciales." Electronic Thesis or Diss., Sorbonne université, 2024. http://www.theses.fr/2024SORUS026.

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Bien pire que la douleur, la dyspnée chez les patients de réanimation placés sous ventilation mécanique est à l'origine d'une souffrance majeure, d'une sensation terrifiante d'asphyxier (mourir asphyxié) sans pouvoir ni la contrôler (powerlessness), ni lui échapper, ni même la signaler aux soignants (helplessness). Elle participe à la survenue du syndrome de stress post-traumatique des patients. L'absence d'attention portée par les soignants à la dyspnée des patients et les difficultés des patients à communiquer avec les soignants leurs symptômes sont à l'origine d'un enjeu de soins crucial, conceptualisé sous le terme « d'invisibilité » de la dyspnée, qui demeure au quotidien une souffrance non-évaluée et non traitée. Cette thèse de science, propose une approche transversale de l'observation de la souffrance respiratoire d'une « autre personne » afin d'apporter des éléments de réponses à la problématique de l'invisibilité de la dyspnée des patients. Une approche pédagogique suggère que le niveau d‘empathie des soignants influence leur capacité à ressentir ce qu'éprouvent les patients et à estimer l'intensité de la dyspnée des patients. Une approche clinique a permis le développement et la validation d'une échelle observationnelle de dyspnée la MV-RDOS permettant de fortement suspecter la dyspnée chez les patients placés sous ventilation mécanique et non-communicant. Enfin, dans une approche fondamentale, ces investigations proposent pour la première fois une description des expressions faciales associées à la dyspnée induite en laboratoire (sujets sains) ainsi qu'une méthode intelligente de reconnaissance faciale automatique des principales expressions faciales de dyspnée. Ces travaux de thèse ouvrent des pistes de développement d'outils de surveillance continue de la souffrance respiratoire des patients de réanimation afin de restaurer la « visibilité » de la dyspnée et mieux la soulager Much worse than pain, dyspnea in intensive care unit (ICU) patients receiving mechanical ventilation is a major cause of suffering, conveying a terrifying sensation of an asphyxial threat, without being able to control it (powerlessness), or escape it, or even report it to caregivers (helplessness). It participates independently in the onset of post-traumatic stress syndrome in survivors of ICU stay. The lack of attention paid by caregivers to patients' dyspnea and the difficulty patients have in communicating their symptoms with caregivers are at the origin of a crucial care issue, conceptualized under the term "invisibility" of dyspnea, which remains an under-assessed and an under-treated suffering in daily practice. This science thesis proposes a transversal approach to observing the respiratory suffering of “another person” in order to provide elements of response to the problem of the invisibility of patients' dyspnea. An educational approach suggests that caregivers' level of empathy influences their ability to feel what patients are experiencing and to estimate the intensity of patients' dyspnea. A clinical approach allowed the development and validation of an observational dyspnea scale, the MV-RDOS, making it possible to strongly suspect dyspnea in noncommunicative, mechanically ventilated patients. Finally, in a fundamental approach, these investigations provide an original description of the facial expressions associated with dyspnea as well as an intelligent method for automatic facial recognition of the main facial expressions of dyspnea. This thesis work opens avenues for developing tools for continuous monitoring of respiratory suffering in the ICU in order to restore the “visibility” of dyspnea and better relieve it

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Dangers, Laurence. "Application du principe de contre-irritation à l'étude des mécanismes neurophysiologiques de la dyspnée : de la physiologie à la thérapeutique." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066132/document.

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L'existence d'une contre-irritation dyspnée-douleur, c'est-à-dire l'inhibition d'une sensation douloureuse par une sensation de dyspnée, permet d'établie une analogie forte dyspnée - douleur. La dyspnée de type " effort inspiratoire excessif " inhibe le réflexe spinal de flexion, ce qui indique qu'elle est au moins en partie médiée par des fibres C. Cette thèse approfondit les connaissances dans ce domaine. Elle montre que la dyspnée de type soif d'air possède des propriétés analgésiques procédant de mécanismes centraux puisqu'elle interagit avec les potentiels évoqués laser qui sont le reflet des mécanismes corticaux mis en jeu au cours de stimulation douloureuse. Elle évalue l'effet d'un antalgique non opioïde de pallier 1, le nefopam, sur une dyspnée expérimentale de type " effort inspiratoire excessif " sans mettre en évidence d'interaction du nefopam avec la contre-irritation dyspnée douleur Dyspnea – pain counter – irritation, namely the inhibition of nociceptive sensation by dyspneic sensation, indicates that dyspnea and pain share some mechanisms. Dyspnea of the work/effort type inhibits the spinal flexion reflex, meaning that it involves C-Fibers. This thesis aims at improving knowledge in this field. It shows that dyspnea of the air hunger type has analgesics properties proceeding from central mechanisms: “air hunger” indeed inhibits laser evoked potentials that depends on the pain-related activation of cortical networks. It also evaluates the effect of a non-opioid first step analgesic, nefopam, on an experimental dyspnea of the “work-effort” type, and shows that although nefopam acts on C-fibers, it does not attenuate dyspnea and does not modify dyspnea-pain counter-irritation as evaluated by laser-evoked potentials. Finally, the thesis brings the first evidence of dyspnea-pain interactions in the clinical setting, by showing that ALS patients treated by non-invasive ventilation exhibit heightened pain sensitivity concomitant to the relief of dyspnea. These data advance the current understanding of dyspnea mechanisms and open new perspectives for treatment evaluation

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Baille, Guillaume. "Atteinte ventilatoire dans la maladie de Parkinson : du symptôme à l’atteinte objective." Thesis, Lille 2, 2019. http://www.theses.fr/2019LIL2S023.

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La maladie de Parkinson (MP) est la deuxième maladie neurodégénérative la plus fréquente. Parmi les nombreux signes cliniques rapportés par les patients et observés par les médecins, les manifestations respiratoires sont encore très peu étudiées.Premièrement, la dyspnée, signe fonctionnel invalidant et altérant la qualité de vie, semble fréquente dans la MP mais sa prévalence et ses caractéristiques (dimension perceptive et réponse émotionnelle notamment) doivent être précisées. L'objectif de l'étude DYSPARK était de mieux définir le profil des patients dyspnéiques, le retentissement de la plainte respiratoire et de corréler ses caractéristiques avec des éléments cliniques de la MP afin de mieux appréhender sa physiopathologie.Deuxièmement, les anomalies ventilatoires objectives (explorations fonctionnelles respiratoires - EFR) sont encore mal connues dans la MP, de même que leur évolution. Une altération des volumes pulmonaires ou une atteinte de la musculature respiratoire pourraient avoir un retentissement sur le cours évolutif de la maladie. L'objectif de l'analyse d'une sous-population de la cohorte PRODIGY-PARK était de déterminer de façon prospective, sur 5 ans, le cours évolutif des données en EFR et leur impact pronostique potentiel Parkinson’s disease (PD) is the second most common neurodegenerative disease. Among the numerous signs reported by the patients and observed by the physicians, respiratory manifestations are one the least explored.Firstly, dyspnea, debilitating symptom that can impair the quality of life, seems to be frequent in PD, but its prevalence and its clinical characteristics (perceptive aspect and emotional response) need to be determined. The objective of the DYSPARK project was to define the clinical profile of dyspneic PD patients, the consequence of the shortness of breath and to correlate its clinical features with the motor and non-motor aspects of the disease.Secondly, objective ventilatory abnormalities (pulmonary function testings – PFT) and the change over time are not well defined in PD. A diminution of lung volumes or impaired respiratory muscles could influence the outcome of the disease. The aim of the analysis of a group of patients from the PRODIGY-PARK cohort was to prospectively assess (5 years follow-up) the PFT data and their possible prognostic impact

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Beaumont, Marc. "Effet de l'entraînement des muscles inspiratoires sur la dyspnée chez des patients atteints de BPCO, en réhabilitation respiratoire." Thesis, Brest, 2017. http://www.theses.fr/2017BRES0044/document.

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Dans le cadre d’un programme de réhabilitation respiratoire (PRR) chez les patients atteints de BPCO, les sociétés savantes recommandent d’inclure un entrainement des muscles inspiratoires (EMI) chez les patients présentant une diminution objective de la force des muscles inspiratoires. Cette recommandation fait suite à une méta-analyse qui suggère qu’un EMI serait bénéfique lorsque la pression inspiratoire (PI) maximale est inferieure a 60 cm H2O.L’entraînement des muscles améliore la force et l’endurance des muscles inspiratoires, la capacité d’exercice et la dyspnée. Dans la dernière méta-analyse, les auteurs précisent que, dans le cadre d’un PRR, il n’est pas certain que l’EMI améliore davantage la dyspnée par rapport à un PRR seul.La question de départ est la suivante : est-ce que l’EMI au cours d’un PRR permet de diminuer davantage la dyspnée qu’un PRR seul ?Dans la première étude contrôlée randomisée, nous montrons que dans le cadre d’un PRR, l’EMI n’améliore pas davantage la dyspnée, chez des patients avec une force des muscles inspiratoires normale. Cependant, une analyse en sous-groupe tend à montrer que chez les patients plus sévèrement atteints (VEMS<50% théorique), l’EMI permettrait une amélioration plus importante de la dyspnée.La deuxième étude est le plus important essai contrôle randomise à propos de l’effet de l’EMI sur la dyspnée dans le cadre d’un PRR. Dans cette étude trois outils différents sont utilisés afin d’évaluer la dyspnée des patients, dont le questionnaire multidimensionnel MDP. Nous montrons que l’EMI ajoute a un PRR n’apporte pas une amélioration significativement plus importante de la dyspnée en comparaison a un PRR seul. Ainsi l’intérêt clinique de l’EMI dans le cadre d’un PRR semble remis en cause During a pulmonary rehabilitation program (PRP) in COPD patients, French and international respiratory societies recommend to include inspiratory muscles training (IMT) in patients with an objective inspiratory muscles weakness. This recommendation follows upon a meta-analysis which suggests that IMT would be beneficial when the maximal Inspiratory pressure (PImax) is lower than 60 cm H2O. IMT improves the strength and the endurance of the inspiratory muscles, the exercise capacity and the dyspnea. In the last meta-analysis, the authors specifies that, when IMT is associated to a PRP, it is not certain that IMT improves more the dyspnea compared with a PRP alone.The initial question of this work is: does IMT during a PRP allow decreasing more the dyspnea than a PRP alone?In the first randomized controlled trial, we show that during a PRP, IMT in COPD patients with normal inspiratory muscles strength does not improve more the dyspnea, compared to a PRP alone. However, an analysis in sub-groups tends to show that in severe or very severe COPD patients (VEMS < 50 % of predictive value), IMT would allow a higher improvement of the dyspnea.The second study is the most important randomized controlled trial about the effect of IMT on the dyspnea during pulmonary rehabilitation. In this study we used three different tools to estimate the dyspnea of the patients, of which the multidimensional Dyspnea Profile questionnaire (MDP). We show that IMT added to a PRP does not improve significantly more dyspnea compared to a PRP alone. So the clinical interest of IMT during a PRP seems questionnable

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KHAL-LAAYOUN, YOUSSEF. "Evaluation de la dyspnee." Lille 2, 1992. http://www.theses.fr/1992LIL2M107.

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Sundström, Robert, and Jesper Forsell. "Sjuksköterskans omvårdnadsåtgärder för patienter med andningssvikt i slutenvården : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3607.

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Bakgrund Andningssvikt är ett tillstånd som uppkommer till följd av problem med gasutbytet i kroppen. Ett flertal respiratoriska sjukdomar som till exempel astma och kroniskt obstruktiv lungsjukdom leder till andningssvikt. Patienter med andningssvikt upplever ofta ett lidande i samband med deras tillstånd och behöver ofta vård inom slutenvården. Sjuksköterskans professionella ansvar inkluderar därför omvårdnad av tillståndets symptom såsom dyspné, samt ett arbete mot att lindra patienters lidande. Syfte Syftet med denna litteraturöversikt var att belysa sjuksköterskors omvårdnad hos vuxna patienter med identifierad andningssvikt inom sluten sjukhusvård. Metod Litteraturöversikt användes som metod. Det inkluderades 15 artiklar i denna litteraturöversikt, dessa söktes fram i databaserna CINAHL och PubMed. Artiklarna granskades av författarna separat och tillsammans. Kvalitativa och kvantitativa artiklar har inkluderats i detta arbete, och analyserats utifrån metoden integrerad analys enligt Kristensson (2014). Resultat Dataanalysen gav upphov till tre kategorier. Dessa var “Sjuksköterskans förutsättning för god identifiering och bedömning av andningssvikt”, “dokumentation av andningssvikt” och “omvårdnadsåtgärder vid andningssvikt”. Det framgick att sjuksköterskor besitter bristande kunskaper om andningssvikt, använder inte evidensbaserade omvårdnadsåtgärder och undervärderar nivån av dyspné hos patienten. Sjuksköterskors vård av patienter med andningssvikt förbättrades vid krav på dokumentation, regelbundna bedömningar, samt användning av instrument och protokoll. Slutsats Bedömning är en viktig aspekt inom omvårdnaden av andningssvikt, och bör utföras regelbundet och i samband med omvårdnad. Det finns en stor variation av bedömningsinstrument och protokoll, och användning av dessa förbättrar sjuksköterskans omvårdnad av patienter med andningssvikt. Dessa verktyg är billiga och enkla att använda, samt kan leda till en hållbar miljö inom vården. Background Respiratory insufficiency is a condition that is caused by problems related to the gas exchange that occurs in the body. Respiratory insufficiency is caused by numerous respiratory diseases like asthma and chronic obstructive pulmonary disease. Patients with respiratory insufficiency often experience an accompanied suffering and may need incare hospital care. Nurses’ professional responsibility therefore includes nursing care for the symptom of the condition such as dyspnea, and a work towards alleviating the patients suffering. Aim The aim of this literature review was to highlight nursing care towards adult patients with identified respiratory insufficiency within incare hospital setting. Method The applied method was a literature review. A search was performed in the bibliographic databases PubMed and CINAHL, and 15 articles was included in the literature review. These articles were reviewed by the authors separately and together. Quantitative and qualitative articles were included, both kinds were analyzed with the method integrated analysis according to Kristensson (2014). Results The data analysis resulted in three categories. These were “Nurses’ condition for good identification and assessment of respiratory insufficiency”, “Documentation of respiratory insufficiency” and “nursing interventions in respiratory insufficiency”. The results showed that nurses have inadequate knowledge about respiratory insufficiency, don’t use evidence-based interventions and underestimate the level of dyspnea among patients. Nursing care was improved with assessments in regularity, documentation requirements, or with the use of measuring instruments or protocols. Conclusions Assessment is an important aspect in nursing care for respiratory insufficiency and should be performed regularly and in liaison with care. There is a broad variety of assessment tools and protocols, and they improve nursing care for patients with respiratory insufficiency. These tools are cheap, easy to use and can lead to a sustainable environment in healthcare.

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Chouihed, Tahar. "Identification des profils congestifs de l'insuffisance cardiaque aiguë pour guider les stratégies diagnostiques et thérapeutiques de prise en charge en urgence." Thesis, Université de Lorraine, 2018. http://www.theses.fr/2018LORR0065/document.

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La dyspnée aigue due à une congestion pulmonaire dans le cadre d’une insuffisance cardiaque aiguë (ICA) est un motif d’admission fréquent aux Urgences. Actuellement, l’ICA est deux fois plus fréquente et est associée à un risque deux fois plus élevé de décès (8%) que les syndromes coronariens aigus (SCA). La prise en charge en pré hospitalier et aux urgences est devenue une étape clé du parcours de soin de ces patients. Ces dernières années ont vu émerger de nouveaux paradigmes autour de la prise en charge de l’ICA mettant en perspective la complexité de cette pathologie. On parle désormais de syndrome d’insuffisance cardiaque aiguë (SICA), terminologie qui souligne la pluralité des situations cliniques et la diversité des profils congestifs. Cependant, l’évaluation de la répartition de la congestion au cours d’un SICA, même s’il existe peu de données sur ce sujet, est actuellement principalement faite sur des arguments cliniques ; l’échographie pulmonaire et l’estimation du volume plasmatique (ePVS, basé sur un calcul intégrant hémoglobine et hématocrite) pourraient permettre de mieux préciser les profils congestifs. Plusieurs études rapportent que la rapidité et l’exactitude du diagnostic étiologique de dyspnée aigue sont associées au pronostic des patients. Malgré l’existence d’outils diagnostiques (biomarqueurs, examens de radiologie), l’incertitude quant au diagnostic étiologique reste importante dans le contexte d’un service d’urgence, ce qui rend difficile la diminution du « Time to therapy » promue par les recommandations de la société européenne de cardiologie 2016. Les objectifs de notre travail étaient d’identifier des profils de congestion distincts d’insuffisance cardiaque aigue, de préciser la valeur diagnostique et pronostique de ces profils dans le contexte d’une dyspnée aigue, et de déterminer si l’effet thérapeutique des modalités de prise en charge initiale en urgence est dépendant de ces profils congestifs. Dans le cadre de notre travail, nous avons pu montrer sur la base des analyses réalisées dans la cohorte DeFSSICA que les outils permettant de mieux préciser le profil congestif des patients (notamment l’échographie pulmonaire et l’ePVS) sont peu utilisés aux urgences. Dans un deuxième travail, nous avons montré sur la cohorte PARADISE (NCT02800122) – conçue dans le cadre de ce doctorat, que l’altération de fonction rénale, l’hyponatrémie et la dysglycémie sont associée de façon significative au pronostic des patients atteints de dyspnée aigue. Dans un troisième travail, nous avons montré que le volume plasmatique estimé est un outil diagnostique performant de SICA et qu’un niveau plus important de congestion évaluée par l’ePVS est associé à une mortalité intra-hospitalière des patients admis pour dyspnée aigue plus élevée. Notre travail a aussi permis de concevoir et démarrer l’étude PURPLE (Pathway and Urgent caRe of dyspneic Patient at the emergency department in LorrainE district – NCT NCT03194243) qui collecte les données cliniques et paracliniques des patients admis pour dyspnée aigue aux urgences de façon prospective dans la région Lorraine. Par ailleurs, ce travail de thèse a aussi permis de concevoir et faire financer le projet EMERALD-US (Evaluation de la faisabilité de la Mise en œuvre et de la performance d’un algorithme d’EchogRraphie Aux urgences pour Le diagnostic de Dyspnée aigue-UltraSound) qui vise à valider un algorithme spécifique aux urgences utilisant l’échographie pulmonaire, cardiaque et vasculaire pour le diagnostic étiologique de dyspnée aigue Acute dyspnea due to pulmonary congestion in acute heart failure (AHF) is a common reason for admission to the ER. Currently, AHF is twice as common and associated with a twofold higher risk of death (8%) than acute coronary syndromes (ACS). Pre-hospital and emergency care has become the cornerstone of care of these patients. In recent years, new paradigms have emerged surrounding AHF management, highlighting the complexity of this disease. Hence the use of the term acute heart failure syndrome (AHFS), a terminology underscoring the plurality of clinical situations and the diversity of congestive profiles. However, the assessment of congestion distribution during an AHFS is currently predominantly based on clinical arguments in spite of limited data. Alternatively, lung ultrasound (LUS) and estimation of plasma volume (ePVS, based on hemoglobin and hematocrit) could allow for a better assessment of congestive profiles. Several studies report that the rapid and accurate etiological diagnosis of acute dyspnea is associated with prognosis. Despite the availability of diagnostic tools including clinical exam, biomarkers and radiology, there is still considerable uncertainty regarding etiological diagnosis in the emergency department (ED) setting, hence rendering it difficult in reducing the « Time to therapy » advocated by the recommendations of the European Cardiology Society 2016 for AHF. The objectives of the present work were to identify distinct congestion profiles of AHF, to clarify the diagnostic and prognostic value of these profiles in the context of acute dyspnea, and to determine whether the therapeutic effect of initial emergency management modalities is dependent on these congestive profiles. In the course of our work, we were able to demonstrate in the DeFSSICA cohort that the tools allowing a better assessment of the patient's congestive profile (particularly LUS and ePVS) are rarely used in ED. In a second study, we showed in the PARADISE cohort (NCT02800122) - designed as part of this PhD research project - that impaired renal function, hyponatremia and dysglycemia are significantly associated with prognosis in patients with acute dyspnea. In a third study, we showed that the ePVS is an effective AHF diagnostic tool and that a higher congestion level assessed by ePVS is associated with higher in-hospital mortality of patients admitted for acute dyspnea. Our work also enabled us to design and initiate the PURPLE (Pathway and Urgent caRe of dyspneic Patients at the emergency department in LorrainE district - NCT03194243) study, which collects clinical and paraclinical data of patients admitted for acute dyspnea on a prospective basis. Lastly, this PhD research project enabled designing and obtain funding for the EMERALD-US project (Evaluation of the feasibility of implementing and performance of an Emergency Echography algorithm for the diagnosis of Acute Dyspnea-UltraSound) which aims to validate an original algorithm specific to emergency situations using lung, cardiac and vascular ultrasound for the etiological diagnosis of acute dyspnea

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Heyse-Moore, Louis Henry. "On dyspnoea in advanced cancer." Thesis, University of Southampton, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295683.

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PEIFFER, CLAUDINE. "La dyspnee : du symptome au cerveau." Paris 7, 1998. http://www.theses.fr/1998PA077268.

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Le travail presente ici a pour but general une meilleure comprehension des mecanismes et de la perception de la dyspnee. Les resultats de nos deux premieres publications, etudes prolongees de la dyspnee spontanee chez des sujets asthmatiques stables mais symptomatiques, ont mis en evidence une importante variation intra et interindividuelle des indices perceptuels etudies : a) la precision de perception (coefficient de correlation entre l'intensite de la dyspnee et un index de l'obstruction bronchique, le debit expiratoire de pointe (dep)) et b) (publication n o2) l'intensite moyenne de la dyspnee pour des niveaux d'obstruction bronchique comparables. Ces indices etaient relies ni a l'instabilite bronchique, ni, en ce qui concerne la precision de perception, a d'autres facteurs de gravite de l'asthme. En revanche, la precision de perception etait meilleure au moment ou l'obstruction bronchique etait maximale (7h et 23h) et chez les sujets qui avaient une importante variation journaliere du dep. Dans notre troisieme etude, nous avons mis en evidence une relation inverse entre l'intensite de l'inflammation bronchique eosinophilique et celle de la dyspnee pour une augmentation donnee de l'obstruction bronchique induite par la bradykinine chez des sujets asthmatiques non traites par corticoides inhales, mais non chez des sujets traites par corticoides et dans le cas d'une obstruction induite par la metacholine. En etudiant les consequences de la transplantation pulmonaire sur la reponse sensorielle et ventilatoire a des charges resistives externes, (publication n o4), nous avons observe que par rapport aux sujets controles, l'intensite de la sensation respiratoire induite etait plus faible pour chaque niveau de pic de pression inspiratoire, son determinant principal, dont les valeurs et l'etendue de variation etaient plus grandes chez les sujets transplantes. Dans notre dernier travail (publication n o5), nous avons pu montrer par imagerie fonctionnelle que la sensation respiratoire induite par des charges resistives externes etait associee a une activation cerebrale specifique comprenant des zones egalement impliquees dans la commande de la reponse respiratoire motrice aux charges (tronc cerebral, cervelet, insula) et une zone localisee dans le gyrus cingulaire posterieur, potentiellement impliquee dans la modulation de sa perception.

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Thomas, Loris A. "COPD dyspnea management by family caregivers." [Tampa, Fla.] : University of South Florida, 2004. http://purl.fcla.edu/fcla/etd/SFE0000541.

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Granget, Jules. "Soulagement de la dyspnée par stimulation olfactive." Electronic Thesis or Diss., Sorbonne université, 2024. http://www.theses.fr/2024SORUS114.

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Notre cerveau orchestre la respiration par un équilibre d'informations sensorielles afférentes et les commandes respiratoires efférentes, volontaires ou autonomes. Une anomalie dans cet équilibre déclenche des sensations d'inconforts respiratoire regroupés sous le terme de « dyspnée ». La dyspnée représente non seulement une douleur physique, mais aussi une détresse psychologique avec une crainte quotidienne de mourir, entraînant de fortes réductions de la qualité de vie. Des opportunités thérapeutiques existent pour corriger les anomalies respiratoires impliquées dans la dyspnée, cependant, elles ne sont pas toujours disponibles et parfois insuffisantes. Dans ces cas, la dyspnée est appelée « persistante » et nécessite de nouvelles approches thérapeutiques pour être soulagée. Dans ce contexte, une stimulation olfactive (SO) pourrait représenter un bon candidat pour traiter la dyspnée persistante. Premièrement, par un impact émotionnel positif car il existe un lien étroit entre le système olfactif et les régions cérébrales impliquées dans la régulation des émotions par rapport à d'autres modalités sensorielles. Ensuite, par son effet sur les paramètres respiratoires. Les odeurs agréables induisent une respiration lente et profonde qui synchronise les rythmes cérébraux, induisant un état de conscience altéré et de relaxation. Et enfin par la stimulation de la branche parasympathique du système nerveux autonome (SNA), favorisant la conscience de soi, le bien-être et la relaxation. Pour explorer cette question, nous avons commencé par identifier, avec des enregistrements électroencéphalographiques intracrâniens (iEEG), les réseaux cérébraux impliqués dans les manœuvres volontaires d'exploration olfactive telles que les sniffs et les apnées, notamment pour explorer son lien avec les régions cérébrales de traitement émotionnel. Ensuite, nous avons utilisé des odeurs agréables et désagréables spécifiques à chaque sujet comme SO pendant l'induction expérimentale de la dyspnée avec une charge mécanique et métabolique tout en enregistrant l'EEG, l'ECG et des tests psychométriques pour tester si les odeurs peuvent soulager la sensation de dyspnée et par quels processus physiologique ce soulagement passe. Concernant les réseaux cérébraux sous-jacents à l'exploration olfactive volontaire, nos résultats nous ont permis d'identifier une modulation de l'activité neuronale dans l'amygdale, l'hippocampe, l'insula postérieure et le cortex temporal. En particulier, nous montrons une augmentation significative de la puissance du theta (4-8Hz) et de l'alpha (8-12Hz) au cours de l'apnée, ainsi qu'une augmentation de la puissance avant le sniff et l'apnée dans ces régions. Ces résultats suggèrent que les manœuvres volontaires respiratoires recrutent des zones limbiques, telles que l'hippocampe et l'amygdale, couramment impliquées dans le processus émotionnel, ainsi que des zones corticales, telles que les cortex temporaux. En ce qui concerne l'impact des odeurs sur les sujets sains pendant la dyspnée expérimentale, nous avons pu mesurer que les odeurs agréables ou désagréables n'ont pas affecté les paramètres respiratoires et n'ont modulé l'effet de la charge mécanique ou métabolique sur le SNA. Lors de l'induction d'une dyspnée expérimentale, les odeurs agréables ou désagréables ont induit des réponses EEG plus élevées par rapport à l'absence d'odeur, avec une odeur désagréable recrutant un réseau plus important pendant l'inspiration par rapport à une odeur agréable. Nous avons également observé que les odeurs agréables induisaient une diminution significative de la dyspnée dans une sous-population de sujets que nous avons qualifiés de « répondeurs », par opposition à une sous-population de « non-répondeurs ». Ces résultats suggèrent qu'une odeur plaisante pourrait soulager la dyspnée en fonction de l'affinité qu'un sujet pourrait avoir pour cette dernière Our brain orchestrates breathing through a balance of afferent information and efferent volitional or autonomous respiratory signals. An anomaly in this balance triggers aversive sensations regrouped under the term of “dyspnea”. Dyspnea represents not only a physical pain, but also a psychological distress with a day-to-day life fear of dying with high decreases for quality of life. Therapeutical opportunities to correct respiratory abnormalities implicated in dyspnea exist, however they are not always available and sometimes not sufficient. In these cases, the dyspnea is called “persistent” and need new therapeutical approaches to be alleviated. In this context, an olfactory stimulation (OS) could represent a good candidate to address persistent dyspnea. Firstly, OS could alleviate dyspnea through a positive emotional impact, there is a close link between the olfactory system and brain regions implicated in emotions regulation comparing to other sensory modalities. Then, through its effect respiratory parameters. Pleasant odors induce a slow and deep breathing that synchronizes brain rhythms, inducing an altered state of consciousness and relaxation. And finally, the fact that an OS stimulates the parasympathetic branch of the autonomic nervous system (ANS), promoting self-awareness and well-being with relaxation. Thus, we propose that an OS can alleviate persistent dyspnea through the interplay of these different aspects.To do so we started by identifying with intracranial electroencephalographic recordings (iEEG) brain networks implicated in volitional olfactory sampling maneuvers such as sniffs and apnea, notably to explore the link between emotion processing brain region and olfactory exploration. Then we used subject specific pleasant and unpleasant odors as OS during experimental dyspnea induction with mechanical and metabolic load while recording EEG, ECG and psychometric tests to test if odors can alleviate dyspnea sensation. Regarding brain networks underlying volitional olfactory sampling, our results enabled us to identify modulation in the amygdala, hippocampus, posterior insula and temporal cortex. Specifically, we measured a significant power increase of theta (4-8Hz) and alpha (8-12Hz) over time during apnea, as well as power increase before sniff and apnea in these regions. These results suggest that both excitatory and inhibitory respiratory maneuvers recruit limbic areas, such as the hippocampus and the amygdala, which are commonly involved in emotional process, and also cortical areas, such as temporal cortices. Regarding odor impact on healthy subjects during experimental dyspnea, pleasant or unpleasant odors did not affect respiratory parameters, and did not potentiate or remove ANS effect for mechanical or metabolic load. During experimental dyspnea, pleasant or unpleasant odors induced higher EEG responses comparing with no odor, with unpleasant odor recruiting a larger network during inspiration comparing to pleasant odor. We also identified that pleasant odor decrease significantly dyspnea in a subpopulation of subjects that we called “responder” in opposition to “non-responder”. Comparing the various physiological recordings measured this study, we can indicate that this dyspnea positive effect is primarily related to changes in brain rhythms given the fact that no alterations in the ANS or respiration were measured

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13

Meek, Paula M. "The cognitive dimension of breathlessness." Diss., The University of Arizona, 1993. http://hdl.handle.net/10150/186540.

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The investigation focused on differences in judgments of individuals experienced with breathlessness (due to chronic pulmonary disease, n = 30) and those without chronic experience (normal lung function, n = 30). The research had three major aims. The first tested whether symptomatic individuals made decisions based in logic and probability or some other means, such as natural assessment strategies. Participants were asked to judge the probability that certain symptom and activity descriptions would be associated with an episode of breathlessness. The results indicated symptomatic judgments based on individualized descriptors are subject to errors in logic and probability. Additionally, the results support the premise that experience with a symptom alters an individual's judgments concerning it. The second aim focused on cognitive representations and their associated influence on the perceptual analysis of breathlessness intensity by testing if the use of a typical cognitive symptom pattern (prototype) or specific remembered symptom instance (exemplar) of breathlessness influenced the determination of symptom intensity or response sensitivity (RS). Magnitude estimation techniques were used to evaluate judgments based on different (prototypes and exemplars) cognitive representations of intensity, using airflow resistance as a stimulus for breathlessness. The results demonstrated a decrease in sensitivity with a prototype and increased RS with an exemplar. This supports that judgments of breathlessness RS vary according to the cognitive representation used. The final aim tested whether cognitive prototypes of symptoms are present with breathlessness and whether these produce different patterns of response. Assuming the existence of a symptom prototype for breathlessness, the study tested whether the responses to two different but symmetrical statements about breathing status differed based on amount of experience with the symptom. The results demonstrated asymmetrical differences between groups and stimuli used supporting the existence and influence of a symptom prototype. Taken together the results suggest individuals make rational (experience-based judgments) versus logical (probability based) decisions concerning their symptoms. Cognitive representations of the symptomatic experience were found to influence judgments of intensity. Cognitive information about symptoms exists in the form of a symptom prototype.

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Garske, Luke Albert. "Determinants of dyspnea associated with pleural effusion." Thesis, Queensland University of Technology, 2018. https://eprints.qut.edu.au/122900/1/Luke_Garske_Thesis.pdf.

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Fluid accumulation between the lung and rib-cage is commonly associated with shortness of breath, and frequently requires hospitalisation and invasive surgical procedures. This program of research has contributed new knowledge which has advanced our understanding of how fluid accumulation between the lung and rib cage causes shortness of breath. A technique was refined to measure the efficiency of the breathing muscles when fluid accumulates between the lung and rib cage. A novel non-invasive therapy to improve efficiency of the breathing muscles was trialled in a patient, and may improve shortness of breath.

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PELLEGRINO, GIULIA MICHELA. "LUNG FUNCTION AND DYSPNEA IN NEUROMUSCULAR DISEASES." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/842435.

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Dyspnea is a common source of suffering for patients affected by cardiorespiratory or neuromuscular diseases. The symptom is complex and encompasses different sensory qualities with distinct intensities. The Multidimensional Dyspnea Profile (MDP) is an instrument specifically developed to assess the multidimensional dimensions of the symptom, and it is applicable in both the research and clinical setting. In order to allow its use for Italian speaking populations, we aimed to provide a linguistically validated, Italian translation of the MDP. We conducted a structured translation and linguistic validation of the MDP questionnaire in accordance to the international guidelines and in cooperation with a specialized company (MAPI SAS, Language Services Unit, Lyon, France). Cognitive interviews on 8 patients were conducted in order to test clarity and understandability of the questionnaire. The multistep process was enriched by several quality checks which led to a translation conceptually equivalent to the original version (American English). A final certified copy linguistically validated Italian translation of the MDP is now available. It measures the intensity of the breathing discomforts in five sensory qualities and assess its intensity and potential reactions. W e here provide an Italian translation and linguistic validation of the MDP. This instrument, allows the assessment of dyspnea in both its sensory and emotional aspects, therefore representing a valuable method for research and therapy purposes.

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Toumi, Mondher. "Modulation pharmacologique de la dyspnee chez l'asthmatique." Aix-Marseille 2, 1993. http://www.theses.fr/1993AIX20114.

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Nicot, Frédéric. "Contributions à l’exploration fonctionnelle respiratoire de l’enfant : mesure de la force des muscles respiratoires et étude de la perception d’une charge respiratoire par les potentiels évoqués respiratoires." Thesis, Paris Est, 2010. http://www.theses.fr/2010PEST0047.

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Certains enfants souffrant de maladies bronchopulmonaires et de maladies neuromusculaires présentent lors de l'évaluation de la force des muscles respiratoires des valeurs anormales et évaluent mal leur état dyspnéique. Le peu de gène respiratoire ressenti par ces patients permet d'émettre l'hypothèse qu'une anomalie de l'intégration corticale des afférences somesthésiques d'origines respiratoires serait responsable. Une nouvelle technique d'exploration neurophysiologique, les potentiels évoqués respiratoires (PER) provoqués par l'occlusion des voies aériennes permet d'investiguer cette voie.Des manoeuvres volitionnelles d'évaluation de la force des muscles respiratoires (Sniffs et SNIP) et non volitionnels (stimulation magnétique) ainsi que les PER ont été enregistrés chez des enfants sains et atteints de pathologies respiratoires et neuromusculaires.Les valeurs de force des muscles respiratoires enregistrées dans les différents groupes étaient semblables. Les composantes des PER enregistrées au sommet de la pariétale ascendante (C3-Cz ; C4-Cz) ont toutes été retrouvées chez les enfants sains et les enfants malades. Seules N1 et P2 ont été plus souvent recueillies chez les patients atteints de maladies neuromusculaires que chez les enfants souffrant de pathologies bronchopulmonaires (p < 0,005).Ces études ont montré que la force des muscles respiratoires peut être évaluée par différentes manœuvres chez les enfants atteints de maladies pulmonaires chroniques et de maladies neuromusculaires et que ces enfants présentent des altérations des PER Some children with chronic lung and neuromuscular diseases showed abnormal values of respiratory muscle strength and misjudge their dyspneic state. These breathing difficulties allow us to hypothesize an abnormal integration of cortical somatosensory afferents. A new neurophysiological approach, Respiratory Related Evoked Potentials (RREPs) caused by upper airways occlusion allows to investigate this pathway.Volitional manoeuvres assessment of the strength of respiratory muscles (Sniff and SNIP) and non-volitional (Magnetic stimulation) and RREPs were recorded in healthy and children suffering from respiratory and neuromuscular diseases.Respiratory muscle strength values recorded in different groups by these techniques were similar. The components of RREPs recorded at C3-Cz and C4-Cz have all been found in healthy children and patients. Only N1 and P2 were more often collected from patients with neuromuscular diseases than in children with lung disease (p <0.005).These studies have shown that muscle strength breathing can be assessed by different manoeuvres in children with chronic lung diseases, neuromuscular diseases and thatChildren show alterations of RREPs

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LLOPIS, BORCZYK CHRISTELLE. "L'epreuve d'effort cardiorespiratoire comme test discriminatif d'une dyspnee." Lille 2, 1990. http://www.theses.fr/1990LIL2M352.

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19

Newton, Phillip J. "The management of dyspnoea in advanced heart failure." Thesis, View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/35551.

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Heart failure is a cause of significant burden to both individuals and society. Individuals live with a disease where there is a decline in physical functioning, the experience of a range of symptoms including breathlessness and pain, frequent hospitalisations and death. The frequent hospital admissions that are usually precipitated by shortness of breath places an economic burden on the current health system. This burden of heart failure is expected to increase in the coming years due to factors such as the ageing population and improved survival from acute cardiac events. This current and predicted continuing burden has been recognised by the health system and has resulted in significant improvement in the pharmacotherapy and nonpharmacotherapy treatment of heart failure. Despite this improvement and with the exception of those few who receive cardiac transplantation, there is no cure for heart failure. Whist the advances in therapy have promoted significant improvements in heart failure management, symptoms including breathlessness (dyspnoea) remain a major issue. The Management of Dyspnoea in Advanced Heart Failure project explored and assessed the current therapeutic management of dyspnoea in advanced heart failure and examined two potential therapeutic options namely nebulised frusemide and long-term oxygen therapy. Following a comprehensive review of the nebulised frusemide literature, The Haemodynamic Effects of Nebulised Frusemide in Heart Failure study showed that nebulised frusemide did have an impact on the haemodynamic parameters of participants. Whilst many consider oxygen therapy as a common sense approach for breathlessness, the lack of scientific evidence for its use in chronic breathlessness with people who have normal or mildly low oxygen levels has prevented funding to supply oxygen therapy to this group of patients. The O2 Breathe Study is a palliative care study that is testing long-term home oxygen therapy versus medical air in patients who do meet the current funding arrangements. The analysis of the screening data showed that the symptom burden as a result of dyspnoea is similar to that seen in cancer and respiratory patients, and heart failure patients had lower levels of physical functioning than the respiratory group. Whilst the design of the studies in this thesis will not allow conclusions to be made regarding their efficacy for dyspnoea management in heart failure, they have provided preliminary data and hypotheses to be tested in the future.

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Newton, Phillip J. "The management of dyspnoea in advanced heart failure." View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/35551.

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Thesis (Ph.D.)--University of Western Sydney, 2008. A thesis submitted to the University of Western Sydney, College of Health and Science, School of Nursing in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographical references.

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Rings, Fabian [Verfasser], and Sven [Akademischer Betreuer] Gottschling. "Die palliative Therapie von Dyspnoe mit transdermal appliziertem Buprenorphin / Fabian Rings ; Betreuer: Sven Gottschling." Saarbrücken : Saarländische Universitäts- und Landesbibliothek, 2019. http://d-nb.info/1197612092/34.

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Timper, Nicole. "NT-proBNP zur Unterscheidung kardialer und respiratorischer Ursachen für Dyspnoe oder Husten beim Hund." Diss., Ludwig-Maximilians-Universität München, 2014. http://nbn-resolving.de/urn:nbn:de:bvb:19-166843.

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23

Talp, Romgård Johanna, and Martin Rödström. "Den prehospitala bedömningen av patienter med dyspné." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-12118.

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Bakgrund: Symtomet dyspné kan vara tecken på en mängd olika sjukdomstillstånd av olika allvarlighetsgrad såsom lungsjukdom, hjärtsjukdom, sepsis etcetera. Upplevelsen av dyspné är subjektiv och känslan av att inte få luft skapar ett obehag och ett lidande hos patienten. En strukturerad och väl utförd bedömning av ambulanssjuksköterskan är grunden för en adekvat behandling. Till ambulanssjuksköterskans hjälp finns riktlinjer för omhändertagande av patienter med dyspné, i dessa riktlinjer ingår primär- och sekundär bedömning med riktade undersökningar elektrokardiogram (EKG), lungauskultation och vitala parametrar (VP). Det finns idag kunskapsluckor gällande ambulanssjuksköterskors följsamhet till de riktlinjer som tillhandahålls, samt i vilken utsträckning den prehospitala bedömningen av patientens sjukdomstillstånd överensstämmer med den hospitala slutbedömningen. Syfte: Att undersöka ambulanssjuksköterskans följsamhet till verksamhetens riktlinjer, samt hur väl bedömd prehospital arbetsdiagnos överensstämmer med bedömd hospital slutdiagnos. Metod: Kvantitativ ansats med ett slumpmässigt retrospektivt urval. Resultat: Fyrahundratolv patientjournaler kodade med ESS 4, dyspné granskades. Medianåldern var 78 år och cirka hälften var män. Resultatet visade att bedömningen av patienter med dyspné var bristfällig. Det fanns en skillnad mellan könen gällande bedömning av neurologi (D), där kvinnor bedömdes i högre grad. Det fanns en skillnad mellan könen i bedömningen av besvärets karaktär (Q) med en ökad bedömning på manliga patienter. Det framkom också en skillnad i bedömningen mellan vuxna och äldre där besvärets karaktär (Q), besvärets utstrålning (R) och vad som föregick insjuknandet (E) bedömdes i högre grad hos äldre. Saturation bedömdes i högre grad hos vuxna än hos äldre. EKG tas i högre grad på äldre än på vuxna. Prehospital diagnos anges i 36,1% av fallen. Av de fallen överensstämmer den prehospitala arbetsdiagnosen med hospital slutdiagnos i 45,3%. Slutsats: ambulanssjuksköterskor brister i bedömningen av patienter med dyspné och följer inte de riktlinjer som finns. Ytterligare forskning behövs för att svara på varför det brister samt om utbildningsnivå korrelerar med följsamhet till behandlingsriktlinjer.

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Burke, Susan P. (Susan Patricia). "Dyspnea and the mechanics of breathing during progressive exercise." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=57002.

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This study investigates dyspnea and the mechanics of breathing during progressive exercise. Three subject groups, athletes, normal sedentary subjects and chronic obstructive diseased patients were studied during progressive exercise testing to exhaustion on a cycle ergometer. Subjects rated dyspnea on a Borg Scale. Inspiratory flow, esophageal/gastric pressures and rib cage/abdominal displacements were measured. Subjects demonstrated two patterns of dyspnea response to changes in esophageal (pleural) pressure. All athletes, two normals and five patients were termed "low dyspnea responders", (LDR), whereas the remaining subjects were termed "high dyspnea responders", (HDR). LDR demonstrated large, rapid negative gastric pressure swings, coupled with outward abdominal displacement during early inspiration when compared to HDR, suggesting that LDR utilized abdominal muscle relaxation at the onset of inspiration. This mechanism appears to provide an extra inspiratory force, contributing to the increasing pleural pressures required. This breathing pattern appears to diminish the sensation of dyspnea at a given pleural pressure.

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Miura, Cinthya Tamie Passos 1983. "Adaptação cultural e validação do instrumento Modified Dyspnea Index." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308903.

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Orientador: Maria Cecilia Bueno Jayme Gallani Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Made available in DSpace on 2018-08-16T05:22:23Z (GMT). No. of bitstreams: 1 Miura_CinthyaTamiePassos_M.pdf: 2254405 bytes, checksum: 18a9c2640fe77f3688ab765ee00381d3 (MD5) Previous issue date: 2010 Resumo: A dispnéia é um dos sintomas cardeais das doenças cardiovasculares, as quais constituem importante causa de morbi e mortalidade no mundo. A subjetividade desse sintoma dificulta sua quantificação acurada, levando ao desenvolvimento de questionários, como o Modified Dyspnea Index (MDI), com o objetivo de avaliar mais especificamente o sintoma. Objetivos: Este estudo teve como objetivo realizar a adaptação cultural do instrumento Modified Dyspnea Index para a língua portuguesa do Brasil; testar sua confiabilidade e sua validade convergente por meio da correlação com o esforço percebido (aplicação da Escala Modificada de Borg), avaliação da força muscular respiratória e avaliação da qualidade de vida relacionada à saúde (aplicação do questionário Minnesota Living with Heart Failure). Metodologia: O processo de adaptação cultural seguiu metodologia recomendada internacionalmente, com as etapas de tradução-retrotradução e avaliação, por comitê de juízes, das equivalências: semântica, idiomática, cultural/experimental, conceitual e metabólica. O Índice de Validade de Conteúdo foi utilizado para avaliar a proporção de concordância entre os juízes. Como se trata de instrumento para uso do profissional de saúde, foi desenvolvido e validado um roteiro para nortear a aplicação do MDI. A confiabilidade foi avaliada segundo o critério da equivalência inter-observador, com aplicação simultânea do instrumento por dois profissionais de saúde (fisioterapeuta e enfermeiro) a pacientes portadores de doença cardiovascular com queixa de dispnéia. A validade foi testada segundo o critério da validade convergente, por meio da correlação entre MDI e: Escala Modificada de Borg, qualidade de vida relacionada à saúde (versão brasileira do Minnesota Living with Heart Failure - LHFQ) e valores de Pressão inspiratória máxima (Pi máx) e Pressão expiratória máxima (Pe máx). Os instrumentos foram aplicados por um único pesquisador, sob forma de entrevista; em seguida, os pacientes foram submetidos à mensuração da Pe máx e Pi máx. A concordância entre os avaliadores independentes, junto a 31 pacientes, foi avaliada por meio do coeficiente Kappa e para o teste das correlações entre o MDI e demais medidas (n=151) foi empregado coeficiente de correlação de Spearman. Foi adotado p? 0,05 como nível de significância. Resultados: O MDI sofreu alterações de acordo com a avaliação da validade de conteúdo. Foi constatado elevado coeficiente de concordância entre os observadores quanto ao escore total do MDI (k= 0,960). Foi observada correlação negativa significativa, embora de pequena magnitude entre MDI e Escala de Borg Modificada (r= -0,29, p=0,0003) e entre MDI e Pi máx e Pe máx (r= 0,26, p=0,0001; e r= 0,28, p=0,0006; respectivamente). A correlação entre o MDI e a medida de qualidade de vida, entretanto, foi de forte magnitude, considerando-se o escore total do LHFQ e sua dimensão física (r= -0,53, p=<0,0001; r= -0,59, p=<0,0001, respectivamente); e de moderada magnitude com a dimensão emocional (r= -0,30, p=<0,0001). A adaptação do MDI para a cultura brasilleira foi realizada com rigor e a análise de sua confiabilidade e validade aponta fortes evidências de ser uma ferramenta útil para avaliação da dispnéia em pesquisa e na prática clínica. Abstract: Dyspnea is an important symptom in cardiovascular diseases, which are important cause of morbidity and mortality worldwide. The subjectiveness of the symptom hampers its accurate quantification. Thus, questionnaires, as the Modified Dyspnea Index (MDI), have been developed in order to provide a more specific evaluation of the symptom. Objectives: The aim of this study were to cross-culturally adapt the instrument Modified Dyspnea Index for the Portuguese language of Brazil, to test its reliability and convergent validity by correlation of its scores with perceived exertion (Modified Borg Scale), respiratory muscle strength evaluation and assessment of health-related quality of life (Minnesota Living with Heart Failure). Methodology: The process of cultural adaptation followed rigorous methodology and included the steps of translation, back translation and evaluation of semantic, idiomatic, cultural and metabolic equivalence by a committee of experts. The Index of Content Validity was used to estimate the proportion of agreement among the judges. As the MDI is designed to be answered by health professionals based on an the evaluation of the patient, a User's Guide for administering the Brazilian-MDI in Portuguese was prepared, with purpose of standardizing its administration and rating. Reliability was assessed according to the criterion of inter-observer equivalence, evaluating the agreement between two health care providers (one nurse and one physiotherapist) regarding individual and total scores of patients with cardiovascular disease with dyspnea. Validity was tested according to the criterion of convergent validity, by the correlation between Brazilian-MDI and: Modified Borg Scale, health-related quality of life (Brazilian version of the Minnesota Living with Heart Failure - LHFQ) and maximal inspiratory (MIP) and maximal expiratory pressure (MEP). The instruments were interviewer- administered by a single researcher, due to the low educational level of the target population. Afterwards, the patients were submitted to the measurement of MIP and MEP. The agreement between the independent observers in 31 patients was evaluated with Kappa's coefficient; Spearman coefficients were used to test the correlations between Brazilian-MDI and the other measures (n=151). The significance level used was p <0.05. Results: Evaluation of the content validity resulted in the rewording of some sentences of the MDI. The coefficient of agreement between the independent observers was k = 0.960.The Brazilian-MDI was negatively and significant but weakly correlated to the Modified Borg Scale (r= -0.29; p=0.0003) and to the Brazilian-MDI and MIP and MEP measures (r= 0.26; p=0.0001 and r= 0.28; p=0.0006; respectively). However, the Brazilian-MDI was highly correlated to the scores of health-related quality of life, considering the LHFQ total score and the physical subscale, (r= -0.53, p=<0.0001; r= -0.59, p=<0.0001, respectively); and the emotional domain (r= -0.30; p=<0,0001). The adaptation of the MDI for use in a Brazilian population has been undertaken with rigor and the tests of its reliability and validity points to strong evidences of being a useful tool for use in research and clinical settings in evaluating dyspnea. Mestrado Enfermagem e Trabalho Mestre em Farmacologia

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Persson, Maria, and Sibi Jellian Engdahl. "Oro relaterat till dyspné vid KOL : Icke-farmakologiska åtgärder." Thesis, Högskolan i Halmstad, Sektionen för hälsa och samhälle (HOS), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-20607.

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Patienter med kronisk obstruktiv lungsjukdom (KOL) upplever ofta oro relaterat till dyspné. Syftet med studien var att undersöka vilka icke-farmakologiska åtgärder som kan vidtas för att lindra patienters oro relaterat till dyspné vid KOL. En litteraturstudie genomfördes där vetenskapliga artiklar granskades och sammanställdes. Resultatet visade att det finns ett flertal icke-farmakologiska åtgärder så som andningstekniker, fysisk träning, avledning, nutrition och kommunikation som sjuksköterskan kan undervisa och informera om för att lindra oro relaterad till dyspné. Åtgärderna bör vara individanpassade, eftersom varje patient är unik. Sjuksköterskan bör själv eller tillsammans med andra vårdinstanser försäkra sig om att patienten får den information och utbildning om sin sjukdom som krävs för att lindra patientens oro i möjligast mån. Informationen och utbildningen bör vara omfattande, för att patienten ska kunna finna de strategier och hjälpmedel som hjälper just dem vid oro. Lungrehabiliteringsprogram visade sig vara av betydelse för patienternas möjlighet att finna strategier för att lindra oro relaterad till dyspné. Ytterligare forskning men även utbildning av sjuksköterskor behövs angående specifika icke-farmakologiska åtgärder som kan lindra oro relaterad dyspné. Det behövs även forskning om vilka icke-farmakologiska åtgärder som bör ingå i ett lungrehabiliteringsprogram. Patients with chronic obstructive pulmonary disease (COPD) often experience anxiety related to dyspnea. The purpose of this study was to investigate the non-pharmacological interventions that can be performed to alleviate patients' anxiety related dyspnea. A literature review was conducted and scientific articles were reviewed and summarized. The results showed that there are several non-pharmacological interventions that nurses can conduct to relieve anxiety related dyspnea, such as breathing techniques, physical exercise, diversion, nutrition and communication. Every patient is unique and therefore should the nurse interventions be individualized. It is the nurse task together with other health care professionals to ensure that the patients receives and understands the information that is given. The information and education should be extensive so that the patient will be able to find the right strategies that will help them to alleviate their anxiety. Pulmonary rehabilitation programs proved to be of great importance to patients' ability to find strategies to relieve anxiety related to dyspnea. Further research and education to nurses are needed on specific non- pharmacological interventions that can relieve anxiety related dyspnea. Research is also needed on which non-pharmacological interventions that should be part of a pulmonary rehabilitation program.

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Park, Soo Kyung. "The dyspnea experience in Korean immigrants with asthma and COPD." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3378502.

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Grant, Christina L. "Anxiety sensitivity and subjective feelings of dyspnea in asthmatic children." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq20829.pdf.

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Skett, Kim A. "Meeting the challenge : The female carers' perspective of managing dyspnoea." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2004. https://ro.ecu.edu.au/theses/807.

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The aim of this descriptive, explorative study was to describe the lived experience of informal carers providing care within the home, to a family member who has lung cancer and the symptom of dyspnoea. Many studies have highlighted the stressors associated with care provision, but no studies have focused on the experience associated with caring for a family member who is dyspnoeic. Ten carers were interviewed regarding their experiences of providing care to the family member during the palliative phase of the illness and while the family member was experiencing the symptom of dyspnoea. Analysis of the initial data highlighted differences in issues identified by nurses and carers, therefore, two Registered Nurses were interviewed to determine how the perceptions of the carers needs differ between the carer and the nurse. Data was collected using unstructured, in-depth interviews which were audio-taped. All data was analysed and common themes identified. Three key themes emerged from the data: developing skills, sustaining the carer and meeting the challenge. In addition to these themes, "developing relationships" emerged as the underpinning concept that supports the themes. The double ABCX model of adaptation and adjustment was used to determine how the carers' perceptions of the stressor and their coping resources influence the process of adaptation. Recommendations have been developed from the findings and are directed towards clinical practice issues, education of carers and areas for further nursing research. The aim of this descriptive, explorative study was to describe the lived experience of informal carers providing care within the home, to a family member who has lung cancer and the symptom of dyspnoea. Many studies have highlighted the stressors associated with care provision, but no studies have focused on the experience associated with caring for a family member who is dyspnoeic. Ten carers were interviewed regarding their experiences of providing care to the family member during the palliative phase of the illness and while the family member was experiencing the symptom of dyspnoea. Analysis of the initial data highlighted differences in issues identified by nurses and carers, therefore, two Registered Nurses were interviewed to determine how the perceptions of the carers needs differ between the carer and the nurse. Data was collected using unstructured, in-depth interviews which were audio-taped. All data was analysed and common themes identified. Three key themes emerged from the data: developing skills, sustaining the carer and meeting the challenge. In addition to these themes, "developing relationships" emerged as the underpinning concept that supports the themes. The double ABCX model of adaptation and adjustment was used to determine how the carers' perceptions of the stressor and their coping resources influence the process of adaptation. Recommendations have been developed from the findings and are directed towards clinical practice issues, education of carers and areas for further nursing research.

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Campion, Sébastien. "Interfaces cerveau-ordinateur pour améliorer l'identification de la dyspnée chez les patients ventilés artificiellement." Thesis, Sorbonne université, 2019. http://www.theses.fr/2019SORUS190.

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Près de la moitié des patients ventilés artificiellement en réanimation présentent un inconfort respiratoire (ou dyspnée). Les difficultés de communication entre patients et soignants rendent complexes l’évaluation et la prise en charge de cette dyspnée. L’objectif de ce travail était de développer des interfaces cerveau-ordinateur (BCI) permettant d’aider les soignants à détecter la dyspnée sous ventilation mécanique (VM) en réanimation. Dans l’étude DYSVENT, des patients dyspnéiques sous VM en réanimation ont été inclus. Un électroencéphalogramme (EEG) était enregistré à l’état basal puis après optimisation des réglages du respirateur à la recherche d’un potentiel pré-inspiratoire (PPI) signe d’une activité corticale liée à la ventilation (ACLV), habituellement absente au cours de la ventilation spontanée. Dans l’étude DYSPEV, deux BCI basées sur des potentiels évoqués visuels en régime permanent (PEVRP) ont été testés chez des volontaires sains : une BCI de détection de la dyspnée (D-BCI) et une BCI de quantification prenant la forme d’une échelle visuelle analogique (EVA) virtuelle (LAS). Les volontaires sains ont été étudiés sous diverses conditions respiratoires : ventilation spontanée (VS), charge inspiratoire à seuil (ITL) et résistive (IRL), inhalation de CO2 (CO2) et retour en VS (VSWO). Différentes fréquences ont été testées pour les stimulus visuels : 12/15Hz, 15/20Hz et 20/30Hz pour la D-BCI et basses fréquences (13, 17, 19, 23 et 29 Hz) et hautes fréquences (41,43,47, 53 et 59 Hz) pour la LAS. Dans l’étude DYSVENT, les patients inclus (n = 47) présentaient un inconfort respiratoire dans 73% à 89% des cas selon la méthode d’évaluation utilisée (EVA ou score d’hétéro-évaluation IC-RDOS ou RDOS). L’optimisation de la ventilation a permis d’améliorer cet inconfort de manière significative. A l’état basal, 38% des patients présentaient un PPI contre 19% après la phase d’optimisation des réglages du respirateur (p < 10-4). Dans l’étude DYSPEV, les volontaires sains inclus (n = 50) présentaient un inconfort respiratoire lors des conditions IRL, ITL et CO2 dans le groupe D-BCI (30 sujets) et lors des conditions ITL et CO2 dans le groupe LAS (20 sujets, condition ITL non testée dans ce groupe) avec des EVA significativement plus élevées comparativement à la VS. Pour la D-BCI, le meilleur réglage de fréquence était 20-30Hz avec une AUC à 0.89 (IC95 [0.80-0.90]) et les basses fréquences pour la LAS avec une AUC à 0.84 (IC95 [0.83-0.85]). Dans l’étude DYSVENT, la détection d’une ACLV était insuffisante pour mettre en évidence des situations à risque d’inconfort respiratoire sous ventilation mécanique. L’étude DYSPEV a permis de faire la preuve de concept chez le volontaire sain de la détection et la quantification d’une dyspnée expérimentale à l’aide d’une BCI basée sur les PEVRP. Une BCI globale combinant ces 2 techniques pourrait être développée pour assister les soignants au quotidien dans la reconnaissance et la prise de l’inconfort respiratoire sous VM en réanimation Almost half of the patients under mechanical ventilation (MV) in intensive care units (ICU) experience respiratory discomfort (or dyspnea). Communication impairments between patients and caregivers in ICU make recognition and evaluation of such a dyspnea difficult. The aim of this work was to develop brain-computer interfaces (BCI) to help caregivers recognizing respiratory discomfort under MV in ICU. In the DYSVENT study, dyspneic patients under MV in ICU were included. An electroencephalogram (EEG) was recorded at baseline and after optimization of ventilator settings. The EEG was analyzed to look for a pre-inspiratory potential (PIP) which is a sign of a ventilation-related cortical activity (VRCA), which is usually absent during spontaneous breathing. In the DYSPEV study, 2 BCIs based on steady-state visual evoked potentials (SSVEP) were tested on healthy volunteers: a BCI that detects dyspnea (D-BCI) and a BCI that quantifies the dyspnea in the form of a virtual visual analogic scale (LAS). Subjects were studies under various respiratory conditions: spontaneous breathing (SB), inspiratory threshold load (ITL) and resistive load (IRL), CO2 inhalation (CO2) and back to SB (SBWO). Many frequency sets were tested: 12/15Hz, 15/20Hz, 20/30Hz for D-BCI and high frequencies (13, 17, 19, 23 and 29 Hz) and low frequencies (41, 43, 47, 53 and 59 Hz) for the LAS. In the DYSVENT study, included patients (n = 47) were dyspneic in 73 to 89% of cases according to the evaluation method used (EVA or the hetero-evaluation scores IC-RDOS or RDOS). The optimization of the ventilator settings significantly improved their discomfort. At baseline 38% of the patients had a PIP on EEG versus 19% after ventilator optimization (p < 10-4). Predictive positive value of PIP detection to identify respiratory discomfort was 1.00 (95CI [0.91-1.00]) using IC-RDOS and 0.96 (95CI [0,87-1,00]) using RDOS. Predictive negative value was 0.37 (95CI [0.25-0.50]) using IC-RDOS and 0.31 (95CI [0.19-0.44]) using RDOS. In the DYSPEV study, healthy volunteers experienced respiratory discomfort during IRL, ITL and CO2 in the D-BCI group (30 subjects) and during ITL and CO2 in the LAS group (20 subjects, ITL condition not tested in this group) with VAS significantly higher than during SB. For the D-BCI the best frequency set was 20-30Hz with AUC 0.89 (95CI [0.80-0.90]) and low frequencies for the LAS with AUC 0.84 (95CI [0.83-0.85]). In the DYSVENT study, VRCA detection was insufficient to highlight situations at risk of respiratory discomfort under MV. The DYSPEV study made the proof of concept in healthy volunteers of using a SSVEP-based BCI to detect and quantify dyspnea. A BCI gathering both techniques could be developed to help caregivers recognizing and taking care of respiratory discomfort under MV in ICU

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Taytard, Jessica. "Interactions croisées cognition-respiration et conséquences d’une activation de la commande ventilatoire corticale : étude chez le sujet sain et les patients atteints du syndrome d’hypoventilation alvéolaire centrale congénitale." Thesis, Sorbonne université, 2019. http://www.theses.fr/2019SORUS378.

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Une commande ventilatoire d’origine corticale peut exister, par exemple lorsque la ventilation est contrainte par des charges mécaniques ou bien lorsque le contrôle automatique est défaillant, comme dans le syndrome d’hypoventilation alvéolaire central congénital (SHACC). L’objectif de ce travail a été de mettre en évidence une compétition de ressources corticales entre ventilation et performances cognitives chez : 1- Des sujets sains soumis à des contraintes ventilatoires mécaniques; 2- Des patients souffrant du SHACC, en ventilation spontanée à l’éveil (VS). 25 sujets sains et 7 patients porteurs de SHACC ont été étudiés à l'aide de tests neuropsychologiques. Chez les sujets sains, ces tests étaient réalisés en ventilation libre et pendant l'application d'une contrainte ventilatoire. Chez les patients, ils ont été réalisés en VS et avec l’appareillage d’assistance ventilatoire du patient. L'impact des différentes conditions a été évalué par l’analyse de la ventilation, celle de la connectivité corticale et des potentiels pré-inspiratoires, et par un questionnaire d’évaluation de la dyspnée. Chez les sujets sains, la ventilation contrainte a induit une modification du profil ventilatoire, une dyspnée et une activation corticale. Elle était associée à une détérioration des tests neurocognitifs mobilisant les capacités attentionnelles. Chez les patients, la VS entraînait une activation corticale associée, au cours des tests, à des désaturations en oxygène, une augmentation de la variabilité respiratoire et des apnées. Il existe donc une compétition entre cognition et ventilation, lorsque cette dernière dépend de la commande corticale In humans, the ventilatory drive can arise from cortical structures. This cortical control is responsible in healthy subjects for the compensation of mechanical inspiratory loading. In patients with congenital central hypoventilation syndrome (CCHS), the cortical ventilatory drive is involved in compensating the inefficient automatic command. The aim of this study was to demonstrate a competition between cerebral resources leading to impaired cognitive performances and/or altered ventilation in: 1- healthy subjects submitted to inspiratory threshold loading (ITL); and 2 – CCHS patients during spontaneous breathing (SB). Twenty-five healthy subjects and seven CCHS patients were studied using neuropsychological tests. In healthy subjects, the tests were performed during SB and while subjects were breathing against the ITL. In CCHS patients, tests were performed during SB and while patients were breathing with their own ventilatory support. The impact of different conditions was studied by ventilatory recordings and cortical connectivity and pre-inspiratory potential analyses. Dyspnea was evaluated using the Multidimensional Dyspnea Profile questionnaire (MDP). In healthy subjects, breathing against the ITL induced breathing pattern modifications, dyspnea and cortical activation. It was associated to decreased performances tests evaluating attention capacities. In patients, SB led to cortical activation associated to desaturations, and an increase in breathing variability and in apnea frequency during neuropsychological tests. We demonstrated a competition between cognition and ventilation when the latter is depending on cortical resources

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Steele, Bonnie Gail. "Dimensions of dyspnea in chronic obstructive pulmonary disease : a nociceptive model /." Thesis, Connect to this title online; UW restricted, 1991. http://hdl.handle.net/1773/7347.

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Hayen, Anja. "Studying the brain mechanisms of dyspnoea with functional magnetic resonance imaging." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:24c95491-4ab0-401c-bf2e-73ce16d61511.

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Dyspnoea (breathlessness) is a debilitating, often poorly controlled, symptom of cardiopulmonary, neurovascular and psychological disorders. This thesis develops the necessary methodology to dissociate aspects of the acute dyspnoea experience using functional magnetic resonance imaging (FMRI) in healthy volunteers. The neuronal mechanisms underlying dyspnoea anticipation, its perceived intensity and unpleasantness and the modulation of these mechanisms by the opioid remifentanil were explored. We investigated the subjective perception of respiratory loading, a commonly used dyspnoea stimulus, and its potential systematic confounds on FMRI due to cerebral blood flow changes. Investigation of the perception of respiratory loading at different levels of hypercapnia (increased end-tidal CO2) showed that hypercapnia should be kept to a minimum to avoid increased baseline respiratory unpleasantness whilst maintaining the stable arterial CO2 (isocapnia) beneficial for FMRI analysis. Investigation of the effects of respiratory loading (± 9 cmH2O) on cerebral blood flow showed that systematic confounds of respiratory loading on perfusion-based neuroimaging data were small (~5%) and did not significantly alter neural activation in response to visual stimulation. Isocapnic respiratory loading during a classical fear-conditioning paradigm during FMRI was used to investigate dyspnoea anticipation, and dissociate the intensity and unpleasantness of acute dyspnoea by modulating unpleasantness with remifentanil. Differential neural networks were found to be involved in perceived intensity (thalamus, insula, somatosensory cortex) and unpleasantness (hippocampus, medial prefrontal cortex). Remifentanil reduced respiratory unpleasantness without affecting the perceived intensity and differentially reduced brain activity during both dyspnoea anticipation and perception. This thesis showed the potential of isocapnic respiratory loading for the study of dyspnoea with FMRI. This stimulus revealed, for the first time, brain activation for dyspnoea anticipation, perceived intensity and unpleasantness. The opioid-sensitive nature of the anticipation and unpleasantness of dyspnoea provides brain targets for future research and might facilitate more effective dyspnoea palliation.

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Webel, Allison R. "Thirty-day analysis of dyspnea and edema in heart failure subjects." Connect to this title online, 2004. https://kb.osu.edu/dspace/handle/1811/176.

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Thesis (Honors)--Ohio State University, 2004. Title from first page of PDF file. Document formatted into pages; contains 31 p.; also includes graphics. Includes bibliographical references (p. 22-23). Available online via Ohio State University's Knowledge Bank.

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Naoum, Christopher. "Pathophysiological mechanisms of cardiogenic dyspnoea in patients with large hiatal hernia." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13891.

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The pathophysiological mechanisms of cardiogenic dyspnoea in patients with large hiatal hernia (HH) are poorly understood. Data obtained from 163 HH patients (Doppler-echocardiography, cardiac CT, MRI, respiratory function and exercise testing) were analysed. Cardiac compression in HH patients involves the left atrium (LA), coronary sinus, inferior pulmonary veins and posterobasal left ventricle; and is associated with significant exercise impairment that improves following corrective surgery. LA compression appears to modulate atrial function at rest to preserve left ventricular (LV) filling by increasing passive LA emptying function to compensate for decreased active emptying volume. LA filling is impaired further after a standardised meal and during preload reduction induced by Valsalva manouevre. Baseline exercise capacity is independently predicted by LA compression and right ventricular outflow tract diameter and, moreover, the improvement in exercise capacity post-operatively is independently predicted by the magnitude of increase in LA diameter. While improvements in lung volumes and reduced gas-trapping are also seen following HH surgery, these are relatively modest compared to the significant resolution of cardiac compression and improvement in exercise capacity. This thesis has systematically defined the cardiac pathophysiology associated with cardiac compression in HH patients and the relationship between these abnormalities and exercise impairment.

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Forsanker, Christian, and Robert Svensson. "Omvårdnad och bemötande av patienter med dyspné : Sjuksköterskors uppfattningar." Thesis, Högskolan i Gävle, Akademin för hälsa och arbetsliv, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-8235.

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Johansson, Andrea, and Anna Johansson. "Upplevelser av dyspné vid kroniskt obstruktiv lungsjukdom : En litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-104703.

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Bakgrund: Kroniskt obstruktiv lungsjukdom är en grupp av lungsjukdomar som långsamt progredierar. Tobaksrökning är vanligaste orsaken till sjukdomens uppkomst, men 20% av alla som drabbas är icke rökare. Det är inte alltid som patienter med sjukdomen känner fysisk smärta, men smärta i form av psykisk, social och existentiell. Ökad dyspné vid återkommande luftvägsinfektioner tyder på att sjukdomen övergått till en kronisk form. Det kan vara svårt för sjukvårdspersonal att avgöra när patienter befinner sig nära döden, då patienterna kan bli bättre under en tid för att sedan avlida oväntat. Syfte: Syftet med studien är att undersöka upplevelser av dyspné hos patienter med kroniskt obstruktiv lungsjukdom. Metod: Studien bygger på den teoretiska referensramen “total pain” och är en litteraturstudie med en integrerad analysmetod för uppsatsen genom att använda sig av forskning från sju vetenskapliga artiklar. Resultat: Resultatet visade att patienter påverkas negativt av dyspnén, vilket resulterade i att de isolerade sig. Detta ledde till social, psykisk och existentiell smärta. Patienterna upplevde att om de som vårdade dem saktade ned sitt tempo i arbetet, så blev de mindre stressade, vilket hjälpte lite med deras dyspné. Vissa patienter var rädda för döden, medan andra var beredda på det och hade börjat planera sina begravningar. Sammanfattning: Resultaten kan tänkas påverka sättet sjuksköterskor vårdar patienterna som lever med kroniskt obstruktiv lungsjukdom och har dessa symtom. Det kan resultera i att kvalitén på vårdandet förbättras och patienterna får en bättre livskvalité. Att använda sig av skattningsskala CAT kan hjälpa sjuksköterskan att identifiera patienters smärta i tidigt skede och på så sätt minska lidande hos patienterna.

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Eliasson, Emilia, and Linnéa Johansson. "Personers upplevelser av att leva med dyspné : en litteraturstudie." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-78561.

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En bakomliggande orsak till dyspné är många gånger lunginsufficiens. Lunginsufficiens beräknas bli den tredje främsta dödsorsaken i världen år 2030. Dyspné kan även uppstå på grund av andra sjukdomar som vårdpersonal möter dagligen. Dyspné är en subjektiv upplevelse av andfåddhet som normaliseras eller förbises då det uppfattas som en naturlig del i sjukdom och åldrande. För att kunna erbjuda en adekvat vård till dessa personer behöver vi förstå deras subjektiva upplevelser, syftet med denna litteraturstudie var därför att beskriva personers upplevelse av att leva med dyspné. I analysen användes kvalitativ innehållsanalys med manifest ansats. Totalt 13 artiklar analyserades för att sammanställa och få en djupare förståelse av personers upplevelser av detta fenomen. Analysen resulterade i fem huvudkategorier som i synnerhet beskriver negativa känslor i form av ångest, rädsla och oro. Studier visade att personer upplevde begränsningar i det dagliga livet som påverkade funktionella, psykiska och sociala aspekter. Personer upplevde att stöd var viktigt på grund av deras nedsatta kapacitet. Aktiviteter hjälpte personer att glömma problem samt motiverade dem till att uppnå en acceptabel livskvalité. Resultatet belyser även olika strategier som personer använde sig av i syfte att undvika dyspné eller förbättra sin andning. Diskussionen tar upp psykiska aspekter och existentiella frågor som dyspné kan orsaka. Den betonar vikten av att sjuksköterskan har kunskap inom dessa områden samt mod att ställa känsliga frågor för att kunna möta personer med dyspné och anpassa vården efter behov. Vidare forskning är därför viktigt för att få fördjupade kunskaper om ämnet.

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Rossi, Stephanie. "COPD patients responding to Tiotropium with dyspnea relief: a proof of efficacy?" Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66898.

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Characteristics of COPD patients who respond to Tiotropium with dyspnea relief Rossi, S., Glady, C., Baril, J., Perrault, H. and Bourbeau, J., RECRU, Montréal Chest Institute, McGill University, Montréal, Québec, Canada. Introduction: Our prescription practice is based essentially on patient self-reporting dyspnea relief. Objective: To assess whether COPD patients (pts) who reported dyspnea relief "tiotropium responders" provide similar response on repeated treatment attempt, and examine the potential underlying physiological determinants of the response. Method: A randomized (TIO or placebo), two-treatment period (2-weeks each), double-blind, cross-over design was conducted using pts characterised as "responder" based on self-reported dyspnea relief and a 1-point decrease on the TDI after the initial 2-week washout period. Each treatment period was preceded by a 2-week washout. Pts were taking Atrovent® and continue their regular medication except for TIO. Total lung capacity (TLC) and inspiratory capacity (IC) were obtained at rest (static hyperinflation) while IC, breathing frequency (BF), tidal volume (VT) and ventilation (VE) and Borg dyspnea scores were obtained at the end of steady-state cycling at 40% and 75% of peak power under both treatment. Paired t-test and a non-parametric analysis were done on all physiological outcomes versus dyspnea scores, as assessed by the TDI and CRQ at each visit. Results: Of the 21 pts recruited, 7 pts (69 ± 7 yrs; FEV1 33 ± 15% pred) drop out due to worsening of respiratory symptoms during washout (n=4) and during placebo treatment period (n=3). In the remaining 14 pts (67 ± 9 yrs; FEV1 55 ± 14%pred), 11 and 10 pts reported decreases in dyspnea on the TDI and CRQ respectively, under TIO. Decreases in dyspnea corresponded to increases in exercise IC and BF in 7 pts and decreases in TLC rest in 7 pts as compared to placebo. Improvements in Borg scores during Les caractéristics des patients MPOC qui répondent au tiotropium par un soulagement de dyspnée Rossi, S., Baril, J., Gladis, C., Perrault, H. et Bourbeau, J., Épidémiologie respiratoire et Unité de recherches cliniques, Institut thoracique de Montréal, Université McGill, Montréal, Québec, Canada. Introduction : Notre pratique en matière de prescription est basée essentiellement sur le soulagement de dyspnée exprimé par le patient. Objectif : Évaluer si les patients MPOC qui ont rapporté un soulagement de dyspnée, « répondeur tiotropium », fournissent une réponse semblable sur la tentative répétée du traitement, et examiner les causes déterminantes physiologiques de la réponse. Méthode : La période de deux traitements (deux semaines chacun) randomisés (TIO ou placebo) à double anonymat croisé, en utilisant des patients caractérisés en tant que « répondeur » basé sur leurs rapports individuels de soulagement dyspnée et de la diminution d'un point sur le TDI après la période initiale d'élimination de deux semaines. Les patients prenaient Atrovent® et continuaient leur médicament habituel excepté le TIO. La capacité pulmonaire totale (TLC) et la capacité inspiratoire (IC) ont été obtenues au repos (hyperinflation statique) tandis que l'IC, la fréquence de respiration (BF), le volume courant (VT), la ventilation (VE), et les pointages de dyspnée de Borg ont été obtenus pendant effort constant à 40 % et à 75 % de puissance maximale pour les deux traitements. Le test t pour échantillons appariés et une analyse non-paramétrique ont été faites sur tous les résultats physiologiques contre les pointages de dyspnée évaluée par le TDI et le CRQ à chaque visite. Résultats : Des 21 patients recrutés, 7 patients (± 69 7 ans; FEV1 33 que le ± 15 % pred) ont lâché en raison de la détérioration des symptômes respiratoires pendant la période d'élimin

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Halank, Michael, Christiane Jakob, Martin Kolditz, et al. "Intimal Pulmonary Artery Sarcoma Presenting as Severe Dyspnea and Right Heart Insufficiency." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-134918.

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Background: Pulmonary artery sarcoma is a rare tumor with a poor prognosis. Case Report: We report the case of a 64-year-old man with an intimal pulmonary artery sarcoma presenting with severe high oxygen flow-demanding dyspnea and weight loss of 12 kg in the last 6 months. On echocardiography, right heart insufficiency, markedly elevated right ventricular pressure, a pressure gradient along the right outflow tract, and a tumor mass adherent to the wall of the truncus pulmonalis were detected. The tentative diagnosis by echocardiographic findings was pulmonary artery sarcoma. Computed tomography of the thorax and 18-fluorodeoxyglucose positron emission tomography showed an advanced local tumor manifestation. Surgical resection of the tumor to improve hemodynamics confirmed the diagnosis. Conclusions: Pulmonary artery sarcoma should be considered as a rare differential diagnosis in patients with dyspnea due to right heart failure, particular in the case of additional weight loss, and echocardiographic examination is a useful first diagnostic approach in establishing the diagnosis Hintergrund: Das Pulmonalarteriensarkom ist eine seltene Erkrankung mit einer schlechten Prognose. Fallbericht: Wir berichten über einen 64-jährigen Mann mit einem intimalen Pulmonalarteriensarkom, der sich mit starker Luftnot trotz hoher Sauerstoffsubstitution und einem Gewichtsverlust von 12 kg in den letzten 6 Monaten vorstellte. Echokardiographisch fielen eine Rechtsherzinsuffizienz, ein deutlich erhöhter rechtsventrikulärer Druck, ein Druckgradient über dem rechten Ausflusstrakt und eine Tumormasse im Bereich des Trunkus pulmonalis mit Kontakt zur Gefäßwand auf. Die mittels Echokardiographie erhobene Verdachtsdiagnose lautete Pulmonalarteriensarkom. Die Computertomographie des Thorax und die 18-Flur-Desoxyglukose-Positron-Emissionstomographie erbrachten den Befund eines lokal fortgeschrittenen Tumors. Die chirurgische Resektion des Tumors, die zur Verbesserung der Hämodynamik durchgeführt wurde, bestätigte die Diagnose. Schlussfolgerungen: Das Pulmonalarteriensarkom sollte differenzialdiagnostisch als eine seltene Ursache der Luftnot im Rahmen einer Rechtsherzinsuffizienz, insbesondere bei zusätzlichem Gewichtsverlust, in Erwägung gezogen werden. Die Echokardiographie stellt eine wertvolle initiale Untersuchungsmethode bei der Diagnosestellung dar Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

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Marines-Price, Rubria. "Sensory and Affective Dimensions of Dyspnea on Exertion in Young Obese Women." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/595631.

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Introduction: Dyspnea on exertion (DOE) is a common symptom experienced by 40% of healthy obese women. Dyspnea has at least two dimensions: a sensory (intensity) and an affective dimension. The affective dimension was measured in this study by unpleasantness and negative emotions (i.e., depression, anxiety, frustration, anger, and fear) related to DOE, measured as rating of perceived breathlessness (RPB). Purpose: To examine whether RPB during exercise was associated with unpleasantness and negative emotions and the relative exercise intensity and to examine whether 12-week exercise training can reduce unpleasantness and negative emotions related to breathlessness in healthy obese women. Methods: A secondary analysis was conducted from data collected from an interventional study. Volunteers underwent body measurements, underwater weighing, pulmonary function testing, and a constant-load cycle test (60 watts). RPB, unpleasantness, and negative emotions related to DOE were obtained. Results: There was a positive relationship (n = 74) between RPB and unpleasantness (r = .61) and RPB and anxiety (r = .50). There was a relationship (n = 52) between unpleasantness and %VO₂max, r = .28 as well as %HRmax r = .38; anxiety and %HRmax, r = .28 (p < .05). Unpleasantness and anxiety were different between groups (n=55). Unpleasantness was higher in the +DOE group (M = 3.91, SD = 2.29) than the–DOE group (M = 1.37, SD = 2.01), t(53) = 4.27, p = < .0001; Anxiety was higher in the +DOE group (M = 2.76, SD = 2.99) than in–DOE group (M = 0.72, SD = 1.23), t(41.95) = 3.45, p = < .001. Within group analysis (n = 13) showed that participants in +DOE experienced a decrease in unpleasantness after 12-week exercise training (p = .013; paired t test). There was a main effect of exercise on unpleasantness (p = .0307) and a group x training interaction (p = .0285) indicating that persons with DOE prior to the exercise intervention experienced less unpleasantness after the intervention. Conclusion: Unpleasantness and anxiety have been identified as the most common symptoms associated with RPB. Healthy obese women who engage in physical activity may experience higher rates of unpleasantness and anxiety based on their relative intensity of exercise. In addition, women with DOE who experience unpleasantness as an associated symptom could possibly decrease the level of unpleasantness if they engage in an exercise-training program.

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PEARSON, SHERIDAN LEIGH. "SPEAKING DYSPNEA: EFFECT OF BREATHING DISCOMFORT ON SPEAKING IN PEOPLE WITH COPD." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/613387.

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Dyspnea (breathing discomfort) in people with COPD is an issue that impacts quality of life. Breathing discomfort can have negative emotional, physical, and mental effects due to chest/lung tightness, anxiety, and fear. By analyzing data of breathing perceptions and breathing patterns of participants, this study aims to determine the effects of breathing discomfort on speaking in people with COPD. The study also looks at which speaking tasks cause the most amount of breathing discomfort and why that may be.

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43

Halank, Michael, Christiane Jakob, Martin Kolditz, et al. "Intimal Pulmonary Artery Sarcoma Presenting as Severe Dyspnea and Right Heart Insufficiency." Karger, 2010. https://tud.qucosa.de/id/qucosa%3A27604.

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Background: Pulmonary artery sarcoma is a rare tumor with a poor prognosis. Case Report: We report the case of a 64-year-old man with an intimal pulmonary artery sarcoma presenting with severe high oxygen flow-demanding dyspnea and weight loss of 12 kg in the last 6 months. On echocardiography, right heart insufficiency, markedly elevated right ventricular pressure, a pressure gradient along the right outflow tract, and a tumor mass adherent to the wall of the truncus pulmonalis were detected. The tentative diagnosis by echocardiographic findings was pulmonary artery sarcoma. Computed tomography of the thorax and 18-fluorodeoxyglucose positron emission tomography showed an advanced local tumor manifestation. Surgical resection of the tumor to improve hemodynamics confirmed the diagnosis. Conclusions: Pulmonary artery sarcoma should be considered as a rare differential diagnosis in patients with dyspnea due to right heart failure, particular in the case of additional weight loss, and echocardiographic examination is a useful first diagnostic approach in establishing the diagnosis. Hintergrund: Das Pulmonalarteriensarkom ist eine seltene Erkrankung mit einer schlechten Prognose. Fallbericht: Wir berichten über einen 64-jährigen Mann mit einem intimalen Pulmonalarteriensarkom, der sich mit starker Luftnot trotz hoher Sauerstoffsubstitution und einem Gewichtsverlust von 12 kg in den letzten 6 Monaten vorstellte. Echokardiographisch fielen eine Rechtsherzinsuffizienz, ein deutlich erhöhter rechtsventrikulärer Druck, ein Druckgradient über dem rechten Ausflusstrakt und eine Tumormasse im Bereich des Trunkus pulmonalis mit Kontakt zur Gefäßwand auf. Die mittels Echokardiographie erhobene Verdachtsdiagnose lautete Pulmonalarteriensarkom. Die Computertomographie des Thorax und die 18-Flur-Desoxyglukose-Positron-Emissionstomographie erbrachten den Befund eines lokal fortgeschrittenen Tumors. Die chirurgische Resektion des Tumors, die zur Verbesserung der Hämodynamik durchgeführt wurde, bestätigte die Diagnose. Schlussfolgerungen: Das Pulmonalarteriensarkom sollte differenzialdiagnostisch als eine seltene Ursache der Luftnot im Rahmen einer Rechtsherzinsuffizienz, insbesondere bei zusätzlichem Gewichtsverlust, in Erwägung gezogen werden. Die Echokardiographie stellt eine wertvolle initiale Untersuchungsmethode bei der Diagnosestellung dar. Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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44

Aleflod, Ebba, and Sandra Hellgren. "Är det här mitt sista andetag - patienters upplevelser av andnöd : En litteraturöversikt." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-6537.

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Bakgrund: Andnöd är ett vanligt symtom som upplevs av patienter med sjukdom i avancerat stadium och beskrivs som svårighet att få luft eller känsla av tung andning vilket kan ge ångest och rädsla. Flera sjukdomstillstånd såsom KOL, lungcancer och hjärtsvikt kan ge upphov till andnöd under den palliativa fasen vars vård syftar till att lindra lidande genom att behandla och förebygga symtom. Sjuksköterskor behöver känna till patienters upplevelser av andnöd för att kunna tillhandahålla samt individanpassa symtomlindring. Syfte: Beskriva upplevelser av andnöd hos personer som erhåller palliativt syftande vård eller vård vid avancerad sjukdom samt deras strategier för att hantera andnöd. Metod: En litteraturöversikt har genomförts med datainsamling från fem databaser som resulterade i 12 vetenskapliga artiklar där 11 var kvalitativa och en kvantitativ. Analysen utfördes utifrån Friberg (2017) och resulterade i två teman. Resultat: De två huvudteman som framkom var Upplevelser av andnöd samt Strategier för hantering av andnöd. Resultatet visade att andnöd gav upphov till ångest och rädsla samt fysisk trötthet och besvärande hosta. Dessutom innebar andnöd inskränkningar av patienters vardag och kunde leda till att de blev socialt isolerade. För att hantera andnöd var en vanlig strategi att anpassa livet efter sina förutsättningar. Diskussion: Metoddiskussionen tar upp författarnas gemensamma arbete, utmaningar och överväganden. Resultatdiskussionen tar bland annat upp hur upplevelsen av andnöd skapar ångest och inskränker patienters vardag. Detta kopplades till Roys adaptionsmodell. Background: Breathlessness is a symptom that makes breathing difficult which can lead to experiences of anxiety and fear. It is one of the most common symptoms experienced by patients with advanced stage disease. Several diseases such as COPD, cancer and heart failure can cause breathlessness. Palliative care aims to alleviate suffering by treating and preventing symptoms, such as breathlessness. Nurses need to be aware of patients´ experiences in order to provide and individually adjust symptomatic relief. Aim: Describe patients´ experiences of breathlessness, while receiving palliative care or receiving care for an advanced disease, including their strategies for managing breathlessness. Method: A literature review was carried out with data collection from five databases that resulted in 12 scientific articles of which 11 were qualitative and one was quantitative. The data analysis was made with Friberg (2017) method and resulted in two themes. Results: The two main themes that emerged were Experiences of breathlessness and Strategies for managing breathlessness. The result showed that breathlessness can cause anxiety and fear, physical fatigue and severe coughing. In addition, breathlessness implied limitations of patients´ daily life and could lead to patients being isolated in their homes, intended or unintended. Different strategies for managing breathlessness are presented. Discussion: In the discussion the pros and cons regarding the authors' joint work, challenges and considerations were addressed. The main findings of the result were discussed using Sister Callista Roy’s adaptation model.

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Nyberg, Jakob, and Ridoan Boulkab. "Sjuksköterskans omvårdnadsinterventioner vid dyspné hos patienter med KOL - En litteraturstudie." Thesis, Karlstads universitet, Avdelningen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-77760.

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Introduktion/bakgrund: Globalt drabbar kroniskt obstruktiv lungsjukdom (KOL) 329 miljoner människor. I Sverige uppskattas 400 000 – 700 000 människor leva med sjukdomen. Prevalensen förutspås att öka på grund av exponering för riskfaktorer och en ökad livslängd. Dyspné är det vanligaste och mest problematiska symtomet för individer med KOL och påverkar flertalet dimensioner av deras liv. Sjuksköterskan har en betydelsefull roll i vården av patienter med KOL. Syfte: Syftet med denna litteraturstudie var att beskriva sjuksköterskans omvårdnadsinterventioner vid dyspné hos patienter med KOL. Metod: Litteraturstudien baserades på Polit och Becks (2016) niostegsmodell. Insamling av artiklar genomfördes i databaserna CINAHL och PubMed. Totalt elva artiklar, tio kvantitativa och en mixed method, återstod efter kvalitetsgranskning Databearbetning: Med en induktiv ansats granskades och diskuterades artiklarnas innehåll vilket resulterade i fyra huvudrubriker. Resultat: Resultatet visade omvårdnadsinterventioner en sjuksköterska kan tillämpa för dyspné hos patienter med KOL. Huvudrubrikerna var omvårdnadsinterventioner med inriktning på sjuksköterskans roll som konsult, omvårdnadsinterventioner med inriktning på utbildning, omvårdnadsinterventioner med inriktning på fysisk aktivitet och komplementär omvårdnadsinterventioner. Slutsats: Omvårdnadsinterventioner som en sjuksköterska utförde för dyspné hos patienter med KOL påvisade förbättrad upplevelse av dyspné, livskvalitet och andra symtom.

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Daisenberger, Patricia. "Nt-proBNP-Messung bei verschiedenen Schweregraden der hypertrophen Kardiomyopathie, anderen Kardiomyopathien sowie zur Unterscheidung kardialer und nicht kardialer Dyspnoe." Diss., lmu, 2010. http://nbn-resolving.de/urn:nbn:de:bvb:19-122094.

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Salinger, Tim [Verfasser], and Jens-Albert [Gutachter] Broscheit. "Die Rolle der B-Linien gestützten Lungensonographie in der Differentialdiagnostik der akuten Dyspnoe / Tim Salinger ; Gutachter: Jens-Albert Broscheit." Würzburg : Universität Würzburg, 2018. http://d-nb.info/1160877130/34.

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Timper, Nicole [Verfasser], and Johannes [Akademischer Betreuer] Hirschberger. "NT-proBNP zur Unterscheidung kardialer und respiratorischer Ursachen für Dyspnoe oder Husten beim Hund / Nicole Timper. Betreuer: Johannes Hirschberger." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2014. http://d-nb.info/1048522350/34.

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Harper, Megan. "Mechanisms of exertional dyspnea in postsurgical patients with non-small cell lung cancer." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/55676.

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Background: Dyspnea is a debilitating symptom reported by patients with non-small cell lung cancer (NSCLC) after pulmonary resection. Reduced ventilatory capacity and respiratory muscle weakness associated with surgery could lead to an imbalance between ventilatory effort and output (a phenomenon known as neuromechanical uncoupling [NMU]) and result in dyspnea. Additionally, augmented pulmonary vascular resistance may impair left ventricular (LV) stroke volume (SV), and contribute to dyspnea and exercise intolerance. It was therefore hypothesized that greater NMU would be associated with dyspnea and exercise intolerance in NSCLC. It was also hypothesized that reduced diastolic filling and decreased LV SV would be associated with dyspnea and exercise intolerance in NSCLC. Methods: Using a cross-sectional design, thirteen post-surgical NSCLC patients performed a pulmonary function test and an incremental cardiopulmonary exercise test, followed by constant-load cycling exercise at 25%, 50%, and 75% Wmax. At 75% Wmax, patients exercised until symptom limitation. The sensory intensity, unpleasantness and sensory qualities of dyspnea were measured during exercise using the modified Borg scale and the multidimensional dyspnea profile. Ventilatory parameters, esophageal pressures, and operational lung volumes were measured continuously; echocardiography was employed during the constant-load trials. Healthy, sedentary age and sex-matched individuals were selected from our database for comparison to the NSCLC group. Results: Patients with NSCLC reported greater intensity of dyspnea for a given power output when compared to controls, particularly during higher intensity exercise. NMU was unchanged throughout exercise despite significant reductions in ventilatory capacity (p<0.05). There was a significant correlation between the resting E/A and exercise tolerance (r² = 0.58; p = 0.035); however, there were no significant correlations observed between ventilatory or cardiovascular parameters and dyspnea or exercise tolerance. Conclusion: In contrast to our hypothesis, we observed no evidence of NMU during exercise in NSCLC. The lack of association between ventilatory parameters and dyspnea suggests that the mechanisms of dyspnea are different from those previously identified in other respiratory diseases. The primary constraint to exercise appeared to be ventilatory limitation secondary to reduced ventilatory capacity and increased ventilatory demand due to peripheral deconditioning. Therapeutic interventions that improve aerobic capacity and reduce ventilatory drive are now warranted with the ultimate aim of reducing dyspnea in this population. Graduate Studies, College of (Okanagan) Graduate

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Perez, Moreno Ana Cristina. "Fatigue and dyspnoea in heart failure : insights from two large randomised clinical trials." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/7077/.

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Heart failure is a complex clinical syndrome characterised by typical symptoms (like dyspnoea, fatigue, palpitations or chest pain) and signs (like oedema, pulmonary crackles, displaced apex beat and increased jugular venous pressure). The possible importance of symptoms as predictors of subsequent outcomes has received little attention in the medical literature yet is clearly of great potential clinical importance (for example in identification, monitoring and treatment of high risk patients). Fatigue and dyspnoea are the two most prevalent symptoms in patients with heart failure ranging from 50-91% for fatigue and similar (53-89%) for dyspnoea. However, the underlying pathophysiological mechanisms of dyspnoea and fatigue in heart failure remain unclear. It has been proposed that decreased oxygen delivery to muscle due to an impaired pump function of the failing heart leads to a build-up of anaerobic metabolic products which may account for both symptoms. Some hypotheses attribute the impaired oxygen delivery to muscle to reduced blood flow due to persistent vasoconstriction and endothelial dysfunction, rather than just to a limited cardiac output. Other potential mechanisms include abnormalities in muscle metabolism, possibly due to changes in cellular subtype, which limit the ability to utilise oxygen and a miss-match between energy requirement and energy production. It has now been recognised that disturbances of central hemodynamic function are no longer the major determinants of exercise capacity in patients with heart failure. If central hemodynamic parameters are improved, there is no immediate change in symptoms, which points to an impaired ability of the muscle to extract oxygen, leading to dyspnoea. The lack of consensus and understanding of the pathophysiological mechanisms of heart failure symptoms, together with poor and subjective tools for their measurement has led to a delay in the development of effective symptomatic treatment. This in turn may have important prognostic implications such as decreased quality of life, increased hospital admissions and even increased mortality. The aim of this work was to examine the correlates of symptoms and change in symptoms. Additionally I set out to examine the association between symptom severity (at baseline and the change in symptom severity over 6 months) and clinical outcomes (namely heart failure hospitalisation, cardiovascular death and all-cause mortality) after adjustment for a series of other known prognostic factors. A cohort of 3830 men and women with LVEF (left ventricular ejection fraction) ≤35% who participated in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA) was examined. This population was chosen because the trial medication (rosuvastatin) had no effect on the primary outcome (composite of death form cardiovascular causes, nonfatal myocardial infarction and nonfatal stroke) (HR 0.92; 95% CI 0.83 to 1.02; P = 0.12) or death from any cause (HR 0.95 in the rosuvastatin group 95% CI, 0.86 to 1.05; P=0.31) compared to placebo, meaning that any result I obtain is unlikely to be due to an effect of the trial drug and because this cohort would be representative of a population with heart failure who were well treated with contemporary evidence-based medicine CORONA was a multicentre, randomised, double-blind, placebo-controlled study which enrolled a total of 5011 patients aged ≥ 60 years with symptomatic (NYHA class II-IV), systolic (LVEF ≤ 40% but no more than 35% in patients with NYHA class II) heart failure. Patients were randomised to receive 10 mg of rosuvastatin or matching placebo once daily. Symptoms were measured at baseline (randomisation visit), 6 weeks after randomisation, and 3 monthly thereafter in this trial population. (1) Investigators were asked to evaluate symptoms using the following statement: “State symptoms during the past few days: Tick lowest level of physical activity causing symptoms”. Fatigue “during the past few days” was measured using a five-point exertion scale (0 none, 1 heavy exertion, 2 moderate exertion, 3 slight exertion, 4 rest), recorded by the investigator. Dyspnoea “during the past few days” was measured using a four-point exertion scale (1 heavy exertion, 2 moderate exertion, 3 slight exertion, 4 rest); a four- rather than five-point scale was used for dyspnoea because the presence of dyspnoea at baseline was an inclusion criterion for CORONA. Data were analysed in several ways to comply with the objectives of this thesis. I examined prevalence and severity of fatigue and dyspnoea by using descriptive statistics. I also analysed baseline characteristics (at visit prior to randomisation and randomisation visit) according to fatigue and dyspnoea severity, reporting means and standard deviations for continuous variables (medians and interquartile ranges for variables that were not normally distributed) and percentages for categorical variables and comparing across symptom groups by running appropriate tests. Ordered logistic regression was used to examine which baseline characteristics were independently associated with symptom severity at baseline, while Cox proportional hazards regression was used to examine how symptoms were related to the risk of clinical events. I used multinomial logistic regression to identify independent predictors of change in symptom severity from baseline to the 6 month visit (chi2 was used to obtain p values), classifying patients as showing a decrease (reduction in score), an increase (an increase in score) or no change (unchanged score) in symptoms and analysed the relationship between change in symptoms and subsequent clinical outcomes using Cox regression. Finally, I examined the effect of rosuvastatin treatment for six months on symptom severity using Cox regression survival analysis. Additionally, a cohort of 8399 patients with chronic symptomatic heart failure with reduced ejection fraction from PARADIGM-HF was examined. Dyspnoea and fatigue on effort in PARADIGM-HF were recorded in every visit as “present” or “absent”. I found that at baseline 95% of CORONA trial participants reported some level of fatigue on exertion and most of them (85%) reported high symptom severity (from moderate exertion to symptoms at rest). In PARADIGM-HF 52% reported fatigue on effort. Dyspnoea showed a similar pattern, although some level of dyspnoea was an inclusion criterion for CORONA where 91% reported dyspnoea from moderate exertion to dyspnoea at rest, while 86% reported dyspnoea on effort in PARADIGM-HF. I found that a limited number of variables (history of hypertension and coronary heart disease; NYHA functional class; and use of mineralocorticoid receptor antagonists) were independently associated with both fatigue and dyspnoea (only with fatigue for PARADIGM-HF), with no variables clearly associated with only one of these symptoms. This similarity in variables associated with each symptom and the lack of association of dyspnoea with ejection fraction or NT-proBNP suggests that “peripheral” (i.e. changes in muscle bulk and metabolism), rather than “central” mechanisms may explain the origin of both symptoms. I also found that worst baseline symptom severity is strongly associated with adverse clinical outcomes, but this association is lost after adjustment for other well-known cardiovascular prognostic variables like NT-proBNP, LVEF and NYHA class, in both cohorts. However in CORONA, change in symptom severity after 6 months was strongly associated with clinical outcomes, even after adjustment for the previously mentioned prognostic factors; with a decrease in symptom severity proving to be protective while an increase over six months being associated with a higher risk of CV death, HF hospitalisation of all-cause mortality. Statin treatment had no convincing effect on symptom severity. In conclusion, I found that both fatigue and dyspnoea were highly prevalent in both cohorts and that they seem to have the same baseline correlates. This supports the theory that both symptoms might be different expressions of the same pathophysiological process. Change in symptom severity after 6 months seems to be strongly associated with outcomes independent of other known prognostic factors, which shines a light on the importance of prompt and targeted interventions to improve symptom severity, or at the very least to prevent deterioration.

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Dissertations / Theses on the topic 'Dyspnoi'

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