Dyspnea in mechanically ventilated critically ill patients*

Schmidt, Matthieu; Demoule, Alexandre; Polito, Andréa; Porchet, R.; Aboab, Jérôme; Siami, Shidasp; Morélot-Panzini, Capucine; Similowski, Thomas; Sharshar, Tarek

doi:10.1097/ccm.0b013e31821e8779

Cited by 154 publications

(180 citation statements)

References 48 publications

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“…This is comparable to the odds of remaining on the ventilator in patients whose dyspnea does not improve after ventilator adjustment. 20 Hypotension was not associated with distress but was associated with intubation. We could not determine if it led to lung or diaphragm injury, distress, and ultimately intubation or if hypotension and distress were caused by the patient's illness.…”

Section: Discussionmentioning

confidence: 99%

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

et al. 2014

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BACKGROUND: When deciding whether mechanical ventilation is indicated, physicians integrate their findings on physical examination in a gestalt known as respiratory distress. Despite its importance, this gestalt is poorly understood. This study aims to describe the association between the rating of the severity of respiratory distress and vital signs, severity of illness, use of mechanical ventilation, and death. A prospective observational study with 1,134 consecutive subjects with uncertain triage evaluated by a critical care consult team was carried out in a public inner city teaching hospital. METHODS: After the initial evaluation of each patient, a critical care physician rated the level of respiratory distress. We recorded vital signs, diagnosis, and laboratory results and calculated the Acute Physiology and Chronic Health Evaluation (APACHE) II score. We recorded if mechanical ventilation was initiated by 72 h and if the subject died during the hospitalization. RESULTS: The most common diagnoses were respiratory illnesses. Higher distress levels were associated with higher breathing frequency (20, 22, 27, and 30 breaths/min, P < .001) and heart rate (96, 101, 109, and 116 beats/min, P < .001) and lower S pO 2 (97, 95, 93, and 92%, P < .001). These variables explain only a small portion of the variance of distress. Distress correlated weakly with the APACHE II score (r ‫؍‬ 0.22, P ‫؍‬ .001). Blood pressure, temperature, Glasgow coma scale score, and laboratory data were unrelated to the levels of distress. However, higher levels of distress correlated with intubation rates (5, 13, 27, and 41%, P < .001). The area under the receiver operating characteristic curve for respiratory distress predicting intubation (0.72) was larger than that for breathing frequency (0.65). Distress was an independent predictor of intubation but not of death. CONCLUSIONS: A physician's rating of respiratory distress is independently predictive of intubation in 72 h. Vital signs explain only a small proportion of variance in distress; the other observations contributing to a physician's rating of distress must be determined.

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Section: Discussionmentioning

confidence: 99%

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

et al. 2014

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“…5 Patients who receive mechanical ventilation are expected to have less dyspnea while ventilated than those without, because mechanical ventilation is the most reliable means of treating dyspnea associated with respiratory failure. However, in a prospective observational study, 4 half of the patients receiving mechanical ventilation or who had a tracheostomy reported dyspnea while receiving mechanical ventilation. Dyspnea can be expected during spontaneous weaning trials and certainly during terminal ventilator withdrawal.…”

Section: Prevalencementioning

confidence: 99%

“…2 Dyspnea is akin to suffocation and is one of the worst symptoms experienced by critically ill patients, including those who are receiving mechanical ventilation. 3,4 …”

mentioning

confidence: 99%

Ensuring Breathing Comfort at the End of Life: The Integral Role of the Critical Care Nurse

Campbell

2018

American Journal of Critical Care

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This article describes the author’s program of clinical research focused on assessment and treatment of respiratory distress among critically ill patients at the end of life. Dyspnea is a subjective experience of breathing discomfort that occurs in the presence of cardiopulmonary and neuromuscular diseases. Dyspnea is one of the most common and most distressing symptoms experienced by critically ill patients. Many critically ill patients, particularly those not expected to survive, become cognitively impaired or unconscious and lose the ability to report symptoms, although dyspnea can be known only from a patient’s report. When self-reporting ability is lost, the critical care nurse must rely on signs indicative of a patient’s respiratory distress. The critically ill patient unable to self-report is vulnerable to under-recognition of symptom distress and subsequent over-treatment or undertreatment. When the patient is dying, there is only 1 chance to optimize the assessment and treatment of symptoms.

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“…98 More recently, Schmidt and co-workers have reevaluated the impact of dyspnea during mechanical ventilation, and particularly the role of asynchrony. 99 The authors studied 96 patients requiring mechanical ventilation for Ͼ 24 hours. Patients were asked if they had dyspnea, using a yes or no response, and then were allowed to qualify the answer as due to air hunger or respiratory effort.…”

Section: Asynchrony and Dyspneamentioning

confidence: 99%

Asynchrony and DyspneaDiscussion

2013

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SummaryPatient-ventilator synchrony and patient comfort are assumed to go hand in hand, yet few studies provide support for this common sense idea. In reality, synchrony between the patient and ventilator is complex and can be affected by the ventilator settings, type of ventilator, patient-ventilator interface, and sedation. Inspections of airway pressure and flow waveforms are reliable methods for detecting asynchrony, and automated detection seems accurate. A number of types of asynchronies have been defined, and asynchrony during invasive and noninvasive ventilation have different calling cards. There is a clear association between asynchrony, ventilator-induced diaphragmatic dysfunction, and duration of mechanical ventilation. Whether these are cause and effect or simply associated remains to be determined.

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Dyspnea in mechanically ventilated critically ill patients*

Abstract: Dyspnea is frequent, intense, and strongly associated with anxiety in mechanically ventilated patients. It can be sensitive to ventilator settings and seems to be associated with delayed extubation.

Cited by 154 publications

References 48 publications

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

Ensuring Breathing Comfort at the End of Life: The Integral Role of the Critical Care Nurse

Asynchrony and DyspneaDiscussion

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