Dyspnea in the weaning patient: assessment and intervention

Dyspnea, the subjective sensation of uncomfortable breathing, is frequently experienced by patients during weaning from mechanical ventilation. As the clinical manifestation of increased work of breathing, dyspnea can be a valuable predictor and indicator of changes in patient respiratory status during the weaning process. The importance of measuring dyspnea is emphasized and the numerical rating and visual analog scales as direct measures of dyspnea are described. The most reliable physiologic variables that can be used to indirectly estimate dyspnea are discussed. Strategies such as positioning, coaching, "bagging," inspiratory muscle training, pressure support ventilation, oxygen, and relaxation/biofeedback techniques that can be used by the critical care nurse to decrease dyspnea are suggested.