title: Underestimation of Patient Breathlessness by Nurses and Physicians during a Spontaneous Breathing Trial.
abstract: BACKGROUND
  Breathlessness is a prevalent and distressing symptom in intensive care unit patients. There is little evidence of the ability of healthcare workers to assess the patient's experiences of breathing. Patient perception of breathing is essential in symptom management, and patient perception during a spontaneous breathing trial (SBT) might be related to extubation success.
  
  
  OBJECTIVE
  To assess mechanically ventilated patients' experiences of breathlessness during SBT.
  
  
  METHODS
  This was a prospective observational multicenter study of 100 mechanically ventilated patients. We assessed the agreement between nurses, physicians, and patients' 11-point Numerical Rating Scales scores of breathlessness, perception of feeling secure, and improvement of respiratory function at the end of an SBT (most performed with some level of support). We also determined the association between breathlessness and demographic factors or respiratory observations.
  
  
  RESULTS
  Sixty-two patients (62%) reported moderate or severe breathlessness (Numerical Rating Scales ≥ 4). The median intensity of breathlessness reported by patients was five compared with two by nurses and physicians (P < 0.001). Patients felt less secure and reported less improvement of respiratory function compared with nurses' and physicians' ratings. About half of the nurses and physicians underestimated breathlessness (difference score, ≤-2) compared with the patients' self-reports. Underestimation of breathlessness was not associated with professional competencies. There were no major differences in objective assessments of respiratory function in patients with moderate or severe breathlessness, and no apparent relationship between breathlessness during the SBT and extubation outcome.
  
  
  CONCLUSIONS
  Patients reported higher breathlessness after SBT compared with nurses and physicians. Clinical trial registered with www.clinicaltrials.gov (NCT 01928277).
authors.affiliation: 1 Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.|2 Department for Research, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.|3 Nord Trøndelag University College, Levanger, Norway.
authors.forename: Hege S
authors.initials: HS
authors.lastname: Haugdahl
authors.affiliation: 1 Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Sissel L
authors.initials: SL
authors.lastname: Storli
authors.affiliation: 4 Department of Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway.
authors.forename: Barbro
authors.initials: B
authors.lastname: Meland
authors.affiliation: 5 Department of Anesthesiology, Nordland Hospital, Bodø, Norway.|6 Faculty of Professional Studies, University of Nordland, Bodø, Norway.
authors.forename: Knut
authors.initials: K
authors.lastname: Dybwik
authors.affiliation: 2 Department for Research, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.|7 Public Health Agency of Sweden, Östersund, Sweden; and.
authors.forename: Ulla
authors.initials: U
authors.lastname: Romild
authors.affiliation: 4 Department of Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway.|8 Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Klepstad
mesh_terms: D000368:Aged; D003422:Critical Care; D064648:Critical Care Nursing; D004417:Dyspnea / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D009726:Nurses; D010820:Physicians; D011446:Prospective Studies; D012119:Respiration; D057566:Self Report; D015300:Ventilator Weaning / Q000706:statistics & numerical data*
keywords: critical care; dyspnea; intensive care; mechanical ventilation; weaning