Respiratory distress is the suffering that results from asphyxiation, and is characterized
by observable behaviors. Standard measures of dyspnea rely on the patient’s ability
to self-report. However, not all patients who experience dyspnea are able to self-report
because of temporary impairments or declining cognition, making them vulnerable to
under-recognition and undertreatment of their distress. Hence, there is a need for
a multidimensional behavioral assessment of respiratory distress. A synthesis of scientific
literature contributed to the development of this model of respiratory distress behaviors.
The proposed model relies on primitive, subcortical, emotional, and autonomic neurologic
systems that are rapidly triggered in response to an asphyxial threat to sustain survival.
The near-immediate activation of autonomic and fear responses from subcortical brain
areas produces observable and measurable behaviors. This proposed model has clinical
and scientific usefulness, if testing characterizes and confirms one or more patterns
of patient behaviors, in response to an asphyxial threat.
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References
- A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease.J Pain Symptom Manage. 2006; 31: 58-69
- Preliminary evidence of impaired thinking in sick patients.Ann Intern Med. 2001; 134: 1120-1123
- Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit.Crit Care Med. 2001; 29: 1370-1379
- The impact of delirium in the intensive care unit on hospital length of stay.Intens Care Med. 2001; 27: 1892-1900
- Occurrence, causes, and outcome of delirium in patients with advanced cancer.Arch Intern Med. 2000; 160: 786-794
- The last 48 hours of life in long-term care: a focused chart audit.J Am Geriatr Soc. 2002; 50: 501-506
- Family perspectives on end-of-life care at the last place of care.JAMA. 2004; 291: 88-93
- A comparison of five pain assessment scales for nursing home residents with varying degrees of cognitive impairment.J Pain Symptom Manage. 2004; 27: 196-205
- Errors in symptom intensity self-assessment by patients receiving outpatient palliative care.J Palliat Med. 2006; 9: 1059-1065
- Breathlessness during exercise with and without resistive loading.J Appl Phsyiol. 1986; 61: 896-905
- Mechanisms of dyspnea.in: Mahler D.A. Dyspnea. Marcel Decker, Inc, New York1998: 63-95
- Stimulus-response characteristics of CO2-induced air hunger in normal subjects.Respir Physiol. 1996; 103: 19-31
- Neuronal sensitivity to hyperoxia, hypercapnia, and inert gases at hyperbaric pressures.J Appl Physiol. 2003; 95: 883-909
- Hypoxic and hypercapnic drives to breathe generate equivalent levels of air hunger in humans.J Appl Physiol. 2003; 94: 141-154
- The genesis of breathlessness: what do we understand?.in: Booth S. Dudgeon D.J. Dyspnoea in advanced disease. Oxford University Press, New York2006: 1-18
- Regional brain activation in humans during respiratory and blood pressure challenges.Clin Exp Pharmacol Physiol. 1998; 25: 483-486
- A brainstem network mediating apneic reflexes in the rat.J Neurosci. 1998; 18: 6048-6056
- Respiratory physiology: the essentials.Lippincott, Williams and Wilkins, Philadelphia1999
- Physiology of behavior.Allyn and Bacon, Boston2001
- The retrosplenial cortex and emotion: new insights from functional neuroimaging of the human brain.Trends Neurosci. 1999; 22: 310-316
- The triune brain in evolution: role in paleocerebral functions.Plenum Press, New York1990
- Human emotion: a functional view.in: Ekman P. Davidson R.J. The nature of emotion: fundamental questions. Oxford University Press, New York1994: 123-126
- Dyspnea and its correlates in Taiwanese patients with terminal cancer.J Pain Sympt Manage. 2004; 28: 123-132
- Acute dyspnea as perceived by patients with chronic obstructive pulmonary disease.Clin Nurs Res. 2003; 12: 85-101
- Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study.Chest. 2006; 130: 133-142
- The emotional brain, fear, and the amygdala.Cell Mol Neurobiol. 2003; 23: 727-738
- The amygdala: vigilance and emotion.Mol Psychiatry. 2001; 6: 13-34
- Autonomic and somatosensor effects of amydala central N. stimulation in awake rabbits.Physiol Behav. 1983; 31: 353-360
- Anxiety and the amygdala: pharmacological and anatomical analysis of the fear-potentiated startle paradigm.in: Bower G. The psychology of learning and motivation. Academic Press, New York1987: 263-305
- State-dependent alteration in respiratory cycle timing by stimulation of the central nucleus of the amygdala.Brain Res. 1984; 306: 1-8
- Evidence that neurons of the central amygdaloid nucleus directly project to the site concerned with circulatory and respiratory regulation in the ventrolateral nucleus of the ca: a WGA-HRP study.Neurosci Lett. 1990; 109: 241-246
- The evolution of asphyxial defense.Integr Physiol Behav Sci. 1993; 28: 317-330
- Connections of the rostral ventral respiratory neuronal cell group: an anterograde and retrograde tracing study in the rat.Brain Res Bull. 1998; 47: 625-642
- Identification of central nervous system neurons innervating the respiratory muscles of the mouse: a transneuronal tracing study.Brain Res Bull. 2002; 57: 335-339
- Breathlessness in humans activates insular cortex.Neuroreport. 2000; 11: 2117-2120
- Evidence for limbic system activation during CO2-stimulated breathing in man.J Physiol. 1995; 488: 77-84
- Neuroimaging of cerebral activations and deactivations associated with hypercapnia and hunger for air.Proc Natl Acad Sci USA. 2001; 98: 2029-2034
- Bold fMRI identifies limbic, paralimbic, and cerebellar activation during air hunger.J Neurophysiol. 2002; 88: 1500-1511
- Brain responses associated with consciousness of breathlessness (air hunger).Proc Natl Acad Sci USA. 2001; 98: 2035-2040
- Neuroimaging evidence implicating cerebellum in the experience of hypercapnia and hunger for air.Proc Natl Acad Sci USA. 2001; 98: 2041-2046
- Neural substrates for the perception of acutely induced dyspnea.Am J Respir Crit Care Med. 2001; 163: 951-957
- Correlations between dyspnea, diaphragm and sternomastoid recruitment during inspiratory resistance breathing in normal subjects.Chest. 1990; 98: 298-302
- Psychophysiologic aspects of dyspnea in chronic obstructive pulmonary disease: a pilot study.Heart Lung. 1990; 19: 252-257
- Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease.J Rehabil Res Dev. 2003; 40: 25-34
- Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study.Crit Care Med. 1999; 27: 73-77
- Alae nasi activation and nasal resistance in healthy subjects.J Appl Physiol. 1982; 52: 1432-1437
- Effect of alae nasi activation on maximal nasal inspiratory airflow in humans.J Appl Physiol. 1998; 84: 2115-2122
- Caring for dying patients who have air hunger.J Nurs Scholar. 2000; 32: 137-143
- A means of measuring facial expressions and a method for predicting emotion categories in clinical disorders of affect.J Affect Disord. 1998; 55: 179-185
- Risk factors for mortality among children hospitalized because of acute respiratory infections in Bangui, Central African Republic.Pediatr Infect Dis J. 2000; 19: 424-432
- Restlessness of respiration as a manifestation of akathisia: five case reports of akathisia.J Clin Psychiatry. 2000; 61: 737-741
- Death in the hospital.Arch Intern Med. 1998; 158: 1570-1572
- The last 48 hours of life.J Palliat Care. 1990; 6: 7-15
- The conditioning of dyspneic suffocation fear: effects of carbon dioxide concentration on behavioral freezing and analgesia.Behav Modif. 2003; 27: 620-636
- The emotional brain.Weidenfeld & Nicolson, New York1998
Beaupré MG, Cheung N, Hess H. La reconnaisance des expressions emotionelles faciales par des decodeurs africains, asiatiques et caucasiens. Paper presented at: 2nd Annual Conference of La Societé Quebecoise de Recherche en Psychologie, 2000.
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