Akutsjukvården syftar till att hjälpa patienter som drabbas av akut ohälsa. Dyspné är en subjektiv känsla av lufthunger eller andnöd och det är individuellt hur en patient upplever detta. Patienter som drabbas av akut dyspné är ofta behov av akutsjukvård för att få hjälp med att underlätta andningsproblemen. Att uppskatta och förstå patienters upplevelse av akut dyspné kan vara utmanande. Patienter med akut dyspné befinner sig i en komplex situation med behov av att bemötas av en god personcentrerad vård där patientens upplevelse och erfarenheter sätts i centrum för vården. Syftet var att belysa vuxna patienters upplevelse av akut dyspné. Metoden i denna studie är en litteraturöversikt med systematisk ansats. Litteratursökningen genomfördes i elektroniska databaserna PubMed och CINAHL där totalt 15 vetenskapliga artiklar valdes ut. Artiklarna kvalitetsgranskades med Caldwells bedömningsmall. De analyserades och granskades med en integrerad analysmetod. Resultatet visar två huvudteman och sju underteman. Patienter beskriver känslor som rädsla, ångest och panik vid akut dyspné. Förutom den subjektiva upplevelsen av akut dyspné beskrivs även upplevelsen av sjukvården vid insjuknande. Upplevelserna och bemötandet av vårdpersonal tyder på brister i den personcentrerade vården där patienterna uttrycker att de inte fick tillräckligt med information och stöd i sitt hälsotillstånd. Trots detta förekom positiva upplevelser där patienter kände tillit till sjukvården trots den skrämmande situation de befann sig i. Utifrån denna litteraturöversikt kan slutsatsen dras att akut dyspné orsakar både fysiskt och psykiskt lidande för patienten. Vårdpersonal måste arbeta med att bygga upp förtroendet och bemötande för att kunna hjälpa patienter som drabbas av akut dyspné. Genom detta kan patienters negativa känslor och upplevelser lindras och genom detta optimeras omhändertagandet av dessa patienter. / Emergency care aims to help patients suffering from acute illness. Dyspnea is a subjective feeling of shortness of breath and how it is experienced differ between persons. Patients suffering from acute dyspnea often need emergency medical care to get help alleviate breathing problems. Estimating and understanding patients' experiences of acute dyspnea can be challenging. Patients with acute dyspnea are in a complex situation and in need of personcentered care where the patient's experiences are taken into account. The aim was to present adult patient's experience of acute dyspnea. The method in this study is a literature review with a systematic approach. The literature search was performed in the electronic databases PubMed and CINAHL, where a total of 15 scientific articles were selected. The articles were quality reviewed with Caldwell's article evaluation template. They were analyzed and examined with an integrated analysis method. Two main themes and seven sub-themes were identified. Patients describe emotions such as fear, anxiety and panic during acute dyspnea. In addition to the subjective experience of acute dyspnea, the experience of healthcare in the event of illness is described. The experiences and the treatment by care staff indicate shortcomings in the person-centered care where the patients express that they did not receive enough information or support regarding their condition. However, there were positive experiences where patients felt confidence in healthcare despite the frightening situation they were in. Based on this literature review, it can be concluded that acute dyspnea causes both physical and mental suffering for the patient. Healthcare professionals must work to build trust in order to help patients suffering from acute dyspnea. By this, patients' negative feelings and experiences can be alleviated, and the care of these patients can be optimized.

Lung cancer is the leading cause of cancer mortality and morbidity. Patients with advanced lung cancer have distressful symptoms like dyspnea. It has severe negative impact on the quality of life. Airway stenting has become widespread for palliation of airway stenosis in patients with metastatic airways disease. Although it provides improvement in symptoms, actual survival benefit is limited with severe potential complications. Appropriate patient selection in terms of site of tumor, type of stent placement is needed to achieve maximum benefit for patients. Here we will discuss 2 patients with advanced lung cancer who received bronchial stent for intractable dyspnea. Although there was dramatic improvement in symptoms and quality of life, both died shortly. Was there any benefit of stenting remained unanswered.

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.

No description available.

The purpose of this study was to investigate the effects of voice production and perception of dyspnea in aerobic instructors during simultaneous tasks of exercise and speech production. The study aimed to document changes that occur during four conditions: 1) voice production without exercise and no use of amplification; 2) voice production without exercise and the use of amplification; 3) voice production during exercise without the use of amplification; 4) voice production during exercise with the use of amplification. Participants included ten aerobic instructors (two male and eight female). The dependent variables included vocal intensity, average fundamental frequency (F0), noise-to-harmonic ratio (NHR), jitter percent (jitt %), shimmer percent (shim %), and participants' self-perception of dyspnea. The results indicated that speech alone, whether it was with or without amplification, had no effect on the sensation of dyspnea. However, when combining speech with exercise, the speech task became increasingly difficult, even more so without the use of amplification. Exercise was observed to inhibit vocal loudness levels as vocal intensity measures were lowest in the conditions with exercise with the use of amplification. Increases in F0 occurred in conditions involving exercise without the use of amplification. Moreover, four participants in various conditions exhibited frequencies that diverged from their gender's normal range. Participants' NHR increased during periods of exercise, however no participants were found to have NHR measures outside the normal range. Four participants were found to have moderate laryngeal pathology that was hemorrhagic in nature. Findings suggest that traditional treatment protocols may need to be modified beyond hygienic approaches in order to address both the respiratory and laryngeal work-loads that are encountered in this population and others involving similar occupational tasks.

No description available.

No description available.

Diploma thesis "Body schema in Patients with Chronic Obstructive Pulmonary Disease" is an experimental work which deals with body schema perception. As a part of the thesis there are particular tests of body schema included, which examine difference between control group and group of patients with chronic obstructive pulmonary disease. Research part of the work deals with current findings about body schema and with findings about chronic obstructive pulmonary disease. There is more detailed analyze of musculoskeletal questions in patients with chronic obstructive pulmonary disease included. In an experimental part of the thesis there are comments on results of the body schema tests. The tests are focused on stereognosis, on position sense, on perception of self body size and on the ability to achieve isolated movement. Powered by TCPDF (www.tcpdf.org)

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.

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