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.
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).
Study Type
OBSERVATIONAL
Enrollment
30
Change in Dyspnea by Visual Analog Scale (D-VAS)
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.
Time frame: Baseline (pre-block), 30 minutes, 8 hours, 16 hours, and 24 hours after the ESP block.
Respiratory Distress Observation Scale (RDOS) Score
Observer-rated RDOS (higher scores indicate more severe respiratory distress); standard scoring per instrument.
Time frame: Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block.
Intensive Care Respiratory Distress Observation Scale (IC-RDOS) Score
Observer-rated IC-RDOS (higher scores worse); standard scoring per instrument.
Time frame: Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block.
Diaphragm Excursion Amplitude on Ultrasound
Peak-to-peak diaphragm excursion amplitude measured bilaterally with bedside ultrasound/M-mode.
Time frame: Baseline (pre-block), 30 minutes
Arterial Blood Gas Parameters: pH, PaO₂, PaCO₂ , SaO₂, HCO₃-
Abstracted from ABGs
Time frame: Baseline (pre-block), 30 minutes, 8 hours, 16 hours, and 24 hours after the ESP block.
Adverse Events Related to ESP Block
Number of participants with any block-related AE within 24 hours, per chart review/clinical documentation.
Time frame: From block through 24 hours.
Respiratory Rate (Breaths/minute)
Respiratory Rate recorded per routine monitoring.
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Time frame: Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block.
Heart Rate (Beats/minute)
Heart rate recorded per routine monitoring.
Time frame: Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block.
SpO₂ (%)
SpO₂ recorded per routine monitoring.
Time frame: Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block.
Blood Pressure (mm-Hg)
Blood Pressure recorded per routine monitoring.
Time frame: Baseline, 30 minutes, 8 hours, 16 hours, 24 hours post-block.