Acute Respiratory Failure (ARF), Dyspnea
Conditions
Keywords
Cervical ESP block, Diaphragm ultrasound, Intensive care, Ultrasound-guided regional anesthesia
Brief summary
Dyspnea is common and distressing in patients with acute respiratory failure. In our intensive care unit, some patients receive a cervical erector spinae plane (ESP) block to help relieve dyspnea. This study will observe patients who receive bilateral cervical ESP blocks and measure changes in dyspnea using validated scales at predefined time points over 24 hours. We will also track vital signs, arterial blood gas values, and diaphragm movement on ultrasound.
Detailed description
Prospective, single-cohort observational study in an adult ICU. Consecutive eligible patients with acute respiratory failure who receive bilateral cervical ESP block will be enrolled. Dyspnea severity will be measured using a 100-mm Dyspnea Visual Analog Scale (D-VAS), the Respiratory Distress Observation Scale (RDOS), and the Intensive Care RDOS (IC-RDOS) before the block (baseline) and at 30 minutes, 8 hours, 16 hours, and 24 hours after the block. Vital signs (respiratory rate, heart rate, peripheral oxygen saturation, blood pressure) will be recorded at the same time points. From arterial blood gases, pH, PaO₂, PaCO₂, SaO₂, and HCO₃- will be abstracted. Bilateral diaphragm excursion amplitude will be measured with bedside ultrasound. Statistical plan includes normality checks; repeated-measures ANOVA for parametric data or Friedman test for nonparametric data; paired t-test or Wilcoxon as needed; chi-square or Fisher's exact for categorical variables. Planned sample size: 30 (power analysis for repeated measures with effect size 0.25, α=0.05, power=0.90).
Interventions
None listed
Sponsors
Hacettepe University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* ICU admission with acute respiratory failure. * Patient or legally authorized representative provides consent. * Cervical ESP block performed for dyspnea treatment
Exclusion criteria
* Infection at block site. * Known diaphragm paralysis. * Known allergy to local anesthetics. * Refusal of consent (patient or representative).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Dyspnea by Visual Analog Scale (D-VAS) | Baseline (pre-block), 30 minutes, 8 hours, 16 hours, and 24 hours after the ESP block. | Patient-reported dyspnea on a 100-mm line (0=no dyspnea, 100=worst imaginable); measured in mm from 0 anchor to the patient's mark. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intensive Care Respiratory Distress Observation Scale (IC-RDOS) Score | Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block. | Observer-rated IC-RDOS (higher scores worse); standard scoring per instrument. |
| Diaphragm Excursion Amplitude on Ultrasound | Baseline (pre-block), 30 minutes | Peak-to-peak diaphragm excursion amplitude measured bilaterally with bedside ultrasound/M-mode. |
| Arterial Blood Gas Parameters: pH, PaO₂, PaCO₂ , SaO₂, HCO₃- | Baseline (pre-block), 30 minutes, 8 hours, 16 hours, and 24 hours after the ESP block. | Abstracted from ABGs |
| Adverse Events Related to ESP Block | From block through 24 hours. | Number of participants with any block-related AE within 24 hours, per chart review/clinical documentation. |
| Respiratory Distress Observation Scale (RDOS) Score | Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block. | Observer-rated RDOS (higher scores indicate more severe respiratory distress); standard scoring per instrument. |
| Heart Rate (Beats/minute) | Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block. | Heart rate recorded per routine monitoring. |
| SpO₂ (%) | Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block. | SpO₂ recorded per routine monitoring. |
| Blood Pressure (mm-Hg) | Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block. | Blood Pressure recorded per routine monitoring. |
| Respiratory Rate (Breaths/minute) | Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block. | Respiratory Rate recorded per routine monitoring. |
Contacts
Primary ContactÇağrı Arslan, Resident
Outcome results
None listed