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Dyspnea in Children with Life-Threatening and Life-Limiting Complex Chronic Conditions
Lucas Pieper1, Boris Zernikow1, Ross Drake2
11 Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health-School of Medicine, Witten/Herdecke University , Datteln, Germany .
Insights
Dyspnea (shortness of breath) is common in children with complex chronic conditions (CCC) needing palliative care, yet it remains poorly studied. Research on its measurement and treatment in these children is limited.
Area of Science:
- Pediatric Palliative Care
- Critical Care Medicine
- Respiratory Medicine
Background:
- Dyspnea is a frequent symptom in children with complex chronic conditions (CCC) requiring palliative care.
- Despite its importance, research on pediatric dyspnea, particularly in critically ill children, is limited.
Purpose of the Study:
- To systematically review the prevalence and causes of dyspnea in children with CCC.
- To identify current research on dyspnea measurement, treatments, and evaluation of interventions in this population.
Main Methods:
- A systematic literature search was conducted on PubMed for studies from 1990 to the present.
- Data on prevalence, pathophysiology, measurement, and treatment of dyspnea were extracted from 43 eligible publications.
Main Results:
- Prevalence of dyspnea varied widely (17%-80%), primarily linked to disease-specific pathophysiology.
- Eight tools assessed dyspnea using subjective or objective measures; a multidimensional approach was not reported.
- Evidence supporting the effectiveness of various treatment approaches for pediatric dyspnea was low.
Conclusions:
- Dyspnea prevalence is high in pediatric palliative care but understudied.
- Existing studies lack adequate and validated measurement tools for diverse pediatric populations and settings.
- Most investigated treatment approaches for pediatric dyspnea lack robust evidence.
Background:
Dyspnea is one of the most frequent symptoms in children with complex chronic conditions (CCC) requiring palliative care. Although it is a subject of high importance, there has been little research on dyspnea in critically ill children.
Objective:
The purpose of this systematic review was to investigate the prevalence and causes of dyspnea in children with CCC and to identify the current state of research on the measurements, treatments, and the evaluation of therapeutic interventions.
Methods:
A systematic literature search for relevant literature from 1990 until the present was performed using the online database PubMed. Information about prevalence, pathophysiological mechanisms, measurement, and treatment of dyspnea was extracted from all 43 eligible publications.
Results:
The prevalence ranged widely from 17% to 80%. Breathlessness was primarily attributed to a disease-specific pathophysiology. A multidimensional approach has not been reported. Assessment of dyspnea included eight tools using either subjective self- or proxy-ratings or objective measures. Evidence for the effectiveness of various treatment approaches was low.
Discussion:
The prevalence rates for dyspnea could be generalized across all conditions and patient subgroups. The biopsychosocial-spiritual approach was not addressed by the studies. There is a lack of an adequate and validated measurement tool that can be applied to children of various ages and diagnoses, communication ability, and practicable across different settings. Most found treatment approaches lacked good evidence in children.
Conclusion:
Although the prevalence rate of dyspnea in pediatric palliative care is high, it has been poorly studied.
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