Fan Therapy for Dyspnea in Lung Transplant Recipients in the Intensive Care Unit: A Before-and-After Study

Introduction Fan therapy has gained attention as a non-pharmacological treatment for alleviating dyspnea in patients receiving palliative care and in those with chronic progressive diseases. However, the effectiveness of fan therapy for dyspnea in critically ill patients in intensive care units (ICUs) remains unclear. This study aimed to investigate the efficacy and safety of fan therapy for lung transplant patients in the ICU. Methods Fan therapy was performed on lung transplant recipients (age >18 years) who experienced dyspnea during their ICU stay. A tabletop portable fan was used to blow air on the patient's face for five minutes providing fan therapy. The intensity of dyspnea before and after the fan therapy was determined, and a statistical analysis was conducted using a paired t-test to evaluate the changes. Results Between May 2023 and February 2024, 16 patients who were admitted to the ICU following lung transplantation were screened, and eight patients received fan therapy. Fan therapy was performed at a median of postoperative day 12. Seven patients (87.5%) received mechanical ventilation via tracheostomy. The mean (±standard deviation) numerical rating scale (NRS) for dyspnea before and after fan therapy was 5.6±2.3 and 4.4±1.5, respectively (p = 0.08). The mean (±standard deviation) respiratory distress observation scale (RDOS) before and after fan therapy was 4.8 ± 2.0 and 3.8 ± 1.7, respectively (p = 0.03). No serious adverse events were observed, and no significant alterations were observed in the respiratory rate, oxygen saturation levels, pulse rate, or blood pressure. Conclusion The findings suggest that fan therapy can be safely used to relieve dyspnea in lung transplant recipients during their ICU stay. Further evaluations in larger trials are required to confirm the results of this study.

Nursing interventions for dyspnoea management among inpatients with cancer in palliative care

BACKGROUND

Dyspnoea, a commonly reported symptom among patients with cancer, necessitates the need for appropriate non-pharmacological interventions for its management and suitable assessment scales.

AIMS

To explore the nursing interventions and assessment scales for managing dyspnoea in patients with cancer receiving palliative care.

METHODS

Systematic review. Five databases (CINAHL Complete, PubMed, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials) were searched, and seven studies were identified. Only studies that comprised randomised controlled trials (RCTs), non-randomised controlled trials or quasi-experimental settings were included.

FINDINGS

Nursing interventions, that support a patient's physical breathing and mental functioning, are effective in managing dyspnoea. It is crucial to use both subjective and physical assessment methods to accurately measure the outcomes of these interventions.

CONCLUSION

These interventions have been proven to be effective, with outcomes centred on changes in physiological measurements and patients' subjective expressions.

Nursing support for breathlessness in patients with cancer: a scoping review

OBJECTIVE

To identify nursing support provided for the relief of breathlessness in patients with cancer.

DESIGN

A scoping review following a standard framework proposed by Arksey and O'Malley.

STUDY SELECTION

Electronic databases (PubMed, CINAHL, CENTRAL and Ichushi-Web of the Japan Medical Abstract Society Databases) were searched from inception to 31 January 2022. Studies reporting on patients with cancer (aged ≥18 years), intervention for relief from breathlessness, nursing support and quantitatively assessed breathlessness using a scale were included.

RESULTS

Overall, 2629 articles were screened, and 27 were finally included. Results of the qualitative thematic analysis were categorised into 12 nursing support components: fan therapy, nurse-led intervention, multidisciplinary intervention, psychoeducational programme, breathing technique, walking therapy, inspiratory muscle training, respiratory rehabilitation, yoga, acupuncture, guided imagery and abdominal massage.

CONCLUSIONS

We identified 12 components of nursing support for breathlessness in patients with cancer. The study results may be useful to understand the actual state of nursing support provided for breathlessness in patients with terminal cancer and to consider possible support that can be implemented.

Safety and Feasibility of Fan Therapy for Dyspnea: A Scoping Review

Fan therapy is a non-pharmacological approach useful in terminally ill patients that relieves dyspnea by directing a fan to blow air on one side of the patient's face. To date, there has been no systematic review of fan therapy for critically ill patients in the intensive care unit. This scoping review aimed to provide a comprehensive overview of fan therapy studies published to date, clarify the therapeutic intervention methods of fan therapy, evaluate its safety according to existing literature, and explore its potential use in critically ill patients. A scoping review was conducted using the Joanna Briggs Institute methodology. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension of the scoping reviews statement. All published studies conducted on patients who received fan therapy regardless of age, disease, setting, phase, country, or follow-up duration were included. The data sources included Medical Literature Analysis and Retrieval System Online, Embase, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Literature databases. Of the 685 studies obtained, 15 were included, comprising patients with terminal cancer and chronic lung diseases. The most common intervention was a single five-minute intervention for dyspnea at rest. The studies on patients receiving oxygen therapy did not report adverse events or worsening of blood pressure, pulse rate, respiratory rate, or SpO2 levels. However, there are no studies in the literature on the use of fan therapy for critically ill patients. Nevertheless, previous studies suggest that fan therapy is safe.

Nursing support for symptoms in patients with cancer and caregiver burdens: a scoping review protocol

INTRODUCTION

Terminally ill patients with cancer experience a variety of symptoms, and their families experience certain caregiver burdens. Most studies on this topic have focused on the symptoms experienced by patients with cancer. There is little established evidence to show how nursing support affects these symptoms and burdens. Nurses provide support by extrapolating their clinical experience, practical knowledge and insights gained from the treatment phase of patients with cancer, regardless of the existence or degree of evidence. This study presents a scoping review protocol with the aim of categorising the feasibility of nursing support from the initial to the terminal phases in the trajectory of cancer care.

METHOD AND ANALYSIS

This review will be guided by Arksey and O'Malley's five-stage scoping review framework and Levac's extension. Our research project team will focus on the pain, dyspnoea, nausea and vomiting, constipation, delirium, fatigue and skin disorders experienced by patients with cancer as well as the burdens experienced by caregivers of such patients. All available published articles from database inception to 31 January 2022 will be systematically searched using the following electrical databases: PubMed, CINAHL, CENTRAL in the Cochrane Library and Ichushi-Web of the Japan Medical Abstract Society databases. In addition, we will assess relevant studies from the reference list and manually search each key journal. The formula creation phase of the literature search involves working with a librarian to identify relevant keywords. At least two reviewers will independently screen and review articles and extract data using a data chart form. Results will be mapped according to study design and analysed for adaptation in the field of terminal cancer.

ETHICS AND DISSEMINATION

This review does not require ethical approval as it is a secondary analysis of pre-existing, published data. The findings will be disseminated through peer-reviewed publications and conference presentations.

Hand-held fans: Physical Properties and Perceptions of Patients with COPD

RATIONALE

Patients with chronic obstructive pulmonary disease (COPD) may remain breathless despite optimal medical treatment. Hand-held fans (HHFs) are recommended to relieve breathlessness, but little is known about physical properties of different fans and the impact HHF properties may have on patient perceptions of fans.

OBJECTIVE

To describe the physical properties of HHFs and investigate the relationship of these properties to patient fan preference.

METHODS

We recruited 33 participants with COPD who were attending a pulmonary rehabilitation program. Participants trialled 5 HHFs in random order. Participants rated perceived airflow, pleasantness of airflow, noisiness, and ease of use of each fan using a 1-10 numerical rating scale (NRS). After trialling all 5 fans, participants ranked each HHF from best (5 arbitrary units; a.u.) to worst (1 a.u.). Rankings for each fan were tallied to produce total HHF scores (T-HHF; maximum=165 a.u.). Objective measurements were made of sound intensity (dB; sound level meter), airflow between 5cm and 30cm from the middle of the fan (anemometer), blade rotation speed, blade size and total fan weight. We assessed the strength of association of T-HHF scores against mean NRS values using Spearman correlation coefficients and used linear regression to compare measured to perceived airflow, and noisiness to sound intensity.

RESULTS

Participants were 68.5 ± 8.9 years (mean ± SD), 63% male, with a median FEV₁ of 0.99L(IQR 0.76-1.31L). There was considerable variability between the 5 fans tested in terms of participant perceptions and physical properties with an almost 5-fold difference in air velocity at 30cm and a 3-fold difference in blade rotation speed. The most preferred fan had a T-HHF score of 140 and had the highest airflow (1.9 m/s) measured at 30cm. T-HHF score positively correlated with pleasantness of airflow (r = 0.46; P < 0.001), perceived airflow (r=0.58; P<0.001) and airflow velocity at 30cm from fan blades (r=1.0; P = 0.02). There were positive linear relationships between fan airflow velocity and perceived air amount, and between measured sound intensity and perceived noisiness(both P<0.001). Women reported significantly higher perceived airflow than men (P < 0.001).

CONCLUSIONS

The physical properties of the five included HHFs are quite distinct. Patient preference was related to pleasantness of airflow, perceived airflow, and measured airflow at 30cm. Gender differences in perceived airflow were noted. Future research should explore the relationship between HHF characteristics and relief of breathlessness.

Relieving from Breathlessness in the Wind: A Meta-Analysis and Subjective Report of Effectiveness of Fan Blowing in Patients with Cardiorespiratory Diseases or Cancer

OBJECTIVES

Breathlessness is common among terminally ill patients with cardiorespiratory disease or cancer. The experience may induce secondary physiological and behavioral responses that limit patient well-being and independence and cause emotional distress.

METHODS

We conducted a meta-analysis on randomized controlled trials (RCTs) that examined the effectiveness of fan blowing on breathlessness among patients with cardiorespiratory diseases or cancer. The PubMed, Cochrane Library, Embase, SCOPUS, and CINAHL databases were searched to retrieve potential articles. The primary outcome was breathlessness severity. The secondary outcomes were SpO₂, anxiety, depression, and quality of life. Also, we presented the changes of vital signs and subjective feeling of a male patient who used fan blowing for relieving his breathlessness.

RESULTS

Eight RCTs were available for analysis. The pooled results demonstrated no significant difference in breathlessness severity between fan-to-face blowing and control methods (standard mean difference: -0.21, 95% confidence interval: -.59 to .17); however, a significant reduction in breathlessness severity was observed in the short-time intervention compared with long-time intervention. A trend occurred toward significance in the reduction of respiratory rate in fan-to-face blowing compared with control methods (MD: -.64, 95% CI: -1.37 to .09). No differences were observed between groups in oxygen saturation, anxiety, depression, or QoL. The male patient who used fan blowing showed an improved vital signs and a satisfied subjective feeling.

CONCLUSIONS

Consistent short-time fan-to-face blowing is effective for relieving breathlessness among conscious terminally ill patients with cardiorespiratory diseases or cancer. The use of this convenient method for relieving breathlessness symptoms in terminally ill patients is recommended.

Lung Cancer-Related Dyspnea: The Effects of a Handheld Fan on Management of Symptoms

BACKGROUND

The application of a handheld fan may reduce patients' shortness of breath and increase their activity tolerance by enabling cooling and air flow into the second and third branches of the trigeminal nerve.

OBJECTIVES

The aim of the study was to assess the effects of directing a handheld fan toward the face in the management of lung cancer-related dyspnea.

METHODS

Using a randomized controlled experimental design, 96 inpatients with lung cancer were evaluated, with the experimental group (n = 49) using a handheld fan to manage dyspnea for 14 days. Dyspnea, respiration rate, oxygen saturation, heart rate, and quality of life were assessed for both groups.

FINDINGS

A statistically significant difference was found in dyspnea scores between groups on the first, seventh, and fourteenth days of fan application, and statistically significant differences were found between groups in dyspnea scores, respiration rates, oxygen saturation, heart rate, and quality of life on the fourteenth day of application.

Immediate Effect of Fan Therapy in Terminal Cancer With Dyspnea at Rest: A Meta-Analysis

Background:

Dyspnea is a common distressing symptom in patients with malignant and nonmalignant diseases. Fan therapy, which uses a fan to blow air toward the patient’s face, can alleviate dyspnea; however, its efficacy remains unclear.

Aim:

To examine the immediate efficacy of fan therapy for alleviation of dyspnea at rest.

Design:

Meta-analysis.

Data sources:

We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and Scopus from January 1, 1987, to August 21, 2018 (PROSPERO-CRD42018108610). In addition, we hand-searched studies and used the similar articles feature on PubMed to search for articles. Randomized controlled trials comparing the effects of fan therapy with placebo or other interventions to alleviate dyspnea at rest, in which patients were aged ≥18 years, were eligible for inclusion in the review. We excluded articles on long-term intervention involving fan therapy and complex intervention (including fan therapy). The risk of bias assessment was conducted using the Cochrane tool, and the meta-analysis was performed using RevMan version 5.3.

Results:

We identified a total of 218 studies; 2 met our criteria for inclusion in the meta-analysis. Fan therapy significantly improved dyspnea at rest in terminally ill patients with cancer compared to control groups (mean difference: −1.31, 95% confidence interval: −1.79 to −0.83, P < .001). There were no studies that met the inclusion criteria regarding fan therapy for patients with nonmalignant disease.

Conclusions:

This meta-analysis demonstrated that fan therapy may be an effective intervention for dyspnea at rest in patients with terminal cancer.

Fan Therapy for the Treatment of Dyspnea in Adults: A Systematic Review

CONTEXT

The use of a handheld or electric fan has been proposed as one component of the complex clinical interventions used in the relief of dyspnea; however, there is a lack of consensus regarding its efficacy.

OBJECTIVES

We performed a systematic review to determine the effectiveness of fan therapy for the treatment of dyspnea.

METHODS

We searched the Medline, EMBASE, Web of Science, Scopus, CINAHL, PsycInfo, and Cochrane Library databases to identify all fan therapy studies published from January 1, 1946 to September 31, 2018. The search terms included "dyspnea," "dysponea," "dyspneic," "short of breath," "shortness of breath," "breathless," "breathlessness," "breathing difficulty," "labored breathing," and "fan." Searches were limited to articles in English or Chinese. The bibliographies of identified articles were also manually searched. Three authors independently assessed papers for inclusion.

RESULTS

Ten of the 92 unique records identified met the inclusion criteria (nine randomized controlled trials and one cohort study). Most studies (80%) were conducted in the hospital setting, and none were double blinded. Nearly half (159 [46%]) of the 344 total subjects had cancer. The most common nonmalignant disease was chronic obstructive pulmonary disease. The most common duration of fan therapy was five minutes. Six studies (60%) reported a significant improvement in dyspnea with fan therapy. There are two ongoing trials being conducted based on a search of trial registries.

CONCLUSION

Limited direct evidence from randomized controlled trials indicates that fan therapy may effectively alleviate dyspnea. Additional trials are warranted to confirm this finding and explore the use of fan therapy for the treatment of dyspnea in more diverse populations and settings.

Fan Therapy Is Effective in Relieving Dyspnea in Patients With Terminally Ill Cancer: A Parallel-Arm, Randomized Controlled Trial

CONTEXT

Dyspnea is a common distressing symptom among patients with advanced cancer.

OBJECTIVE

The objective of this study was to determine the effect of fan therapy on dyspnea in patients with terminally ill cancer.

METHODS

This parallel-arm, randomized controlled trial included 40 patients with advanced cancer from a palliative care unit at the National Cancer Center Hospital in Japan. All patients experienced dyspnea at rest with a score of at least three points on a subjective 0- to 10-point Numerical Rating Scale (NRS), showed peripheral oxygen saturation levels of ≥90%, had an Eastern Cooperative Oncology Group grade of 3 or 4, and were aged 20 years or more. In one group, a fan was directed to blow air on the patient's face for five minutes. This group was compared to a control group wherein air was blown to the patient's legs. Patients were randomly assigned to each group. The main outcome measure was the difference in dyspnea NRS scores between fan-to-face and fan-to-legs groups.

RESULTS

No significant differences were seen in baseline dyspnea NRS between groups (mean score, 5.3 vs. 5.1, P = 0.665). Mean dyspnea changed by -1.35 points (95% CI, -1.86 to -0.84) in patients assigned to receive fan-to-face and by -0.1 points (-0.53 to 0.33) in patients assigned to receive fan-to-legs (P < 0.001). The proportion of patients with a one-point reduction in dyspnea NRS was significantly higher in the fan-to-face arm than in the fan-to-legs arm (80% [n = 16] vs. 25% [n = 5], P = 0.001).

CONCLUSION

Fan-to-face is effective in alleviating dyspnea in patients with terminally ill cancer.