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Detection and management of dyspnea in mechanically ventilated patients

Decavèle, Maxensa,b; Similowski, Thomasa,b; Demoule, Alexandrea,b

Current Opinion in Critical Care: February 2019 - Volume 25 - Issue 1 - p 86–94
doi: 10.1097/MCC.0000000000000574
RESPIRATORY SYSTEM: Edited by Laurent J. Brochard and Tài Pham
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Purpose of review In ICU patients, dyspnea is one of the most prominent and distressing symptom. We sought to summarize current data on the prevalence and prognostic influence of dyspnea in the ICU setting and to provide concise and useful information for dyspnea detection and management.

Recent findings As opposed to pain, dyspnea has been a neglected symptom with regard to detection and management. Many factors contribute to the pathogenesis of dyspnea. Among them, ventilator settings seem to play a major role. Dyspnea affects half of mechanically ventilated patient and causes immediate intense suffering [median dyspnea visual analog scale of 5 (4–7)]. In addition, it is associated with delayed extubation and with an increased risk of intubation and mortality in those receiving noninvasive ventilation. However, one-third of critically ill patients are noncommunicative, and therefore, at high risk of misdiagnosis. Heteroevaluation scales based on physical and behavioral signs of respiratory discomfort are reliable and promising alternatives to self-report.

Summary Dyspnea is frequent and severe in critically ill patients. Implementation of observational scale will help physicians to access to noncommunicative patient's respiratory suffering and tailor its treatment. Further studies on the prognostic impact and management strategies are needed.

aSorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique

bAP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie Medecine Intensive Réanimation du Département R3S, Paris, France

Correspondence to Professor Alexandre Demoule, MD, Service de Pneumologie Médecine Intensive Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l’Hôpital, 75013 Paris, France. Tel: +33 1 42 16 77 61; fax: +33 1 42 16 78 43; e-mail: alexandre.demoule@aphp.fr

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