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Dyspnea in mechanically ventilated critically ill patients.
Matthieu Schmidt1, Alexandre Demoule, Andrea Polito
1Assistance Publique-Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Critical Care Medicine
|May 17, 2011
Summary
Dyspnea, or difficulty breathing, is common in mechanically ventilated patients and linked to anxiety. Adjusting ventilator settings can help, but unresolved dyspnea may delay extubation.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Patient Comfort
Background:
- Ensuring patient comfort in intensive care units (ICUs) is vital.
- While pain management is well-studied, dyspnea in mechanically ventilated patients remains under-researched.
- Understanding dyspnea is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of dyspnea in mechanically ventilated patients.
- To identify clinical factors associated with dyspnea.
- To examine the impact of dyspnea on clinical outcomes, including extubation success.
Main Methods:
- A 6-month prospective observational study was conducted in two university hospital medical ICUs.
- 96 intubated or tracheotomized patients requiring mechanical ventilation for over 24 hours were enrolled.
- Dyspnea was assessed using a yes-no question, visual analog scale, and descriptor choice; pain and anxiety were also measured.
Main Results:
- Nearly half of patients (47%) reported dyspnea, often described as 'air hunger' or 'respiratory effort'.
- Dyspnea was significantly associated with higher anxiety levels (OR 8.84), assist-control ventilation (OR 4.77), and increased heart rate.
- Improving dyspnea by adjusting ventilator settings occurred in 35% of patients, and unresolved dyspnea was linked to less frequent successful extubation within 3 days (17% vs 40%).
Conclusions:
- Dyspnea is a frequent and intense symptom in mechanically ventilated patients.
- A strong correlation exists between dyspnea and anxiety in this population.
- Dyspnea appears responsive to ventilator adjustments and may predict delayed extubation.
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