The Mechanical Ventilation–Respiratory Distress Observation Scale as a surrogate of self-reported dyspnoea in intubated patients. Issue 4 (11th October 2018)

• Record Type: Journal Article
• Authors: Decavèle, Maxens; Gay, Frédérick; Persichini, Romain; Mayaux, Julien; Morélot-Panzini, Capucine; Similowski, Thomas; Demoule, Alexandre
• Is Part Of: European respiratory journal. Volume 52:Issue 4(2018)
• Publication Date: 2018-10-11
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.00598-2018
• Languages: English
• ISSNs: 0903-1936

Abstract

Intensive care unit (ICU) patients are exposed to many sources of discomfort, among which dyspnoea is one of the more severely distressing [1]. In invasively mechanically ventilated patients, dyspnoea is frequent (47% of intubated patients report breathing discomfort when they can first communicate with caregivers) and severe (median rating of 5 on a dyspnoea visual analogue scale (D-VAS); association with anxiety and neurovegetative signs of stress) [2]. It is often linked to ventilator settings and seems to be associated with poorer clinical outcomes ( e.g. delayed extubation and post-traumatic stress disorders) [2, 3]. As in other settings, identifying and quantifying dyspnoea in mechanically ventilated patients is therefore a major clinical issue. This is challenging because self-report and self-assessment, prerequisites for D-VAS assessment [4], are often impossible or very difficult in this setting. Unfortunately, caregivers markedly underestimate dyspnoea in this context [5, 6]. The risk of occult respiratory suffering is therefore major in the ICU setting and neglecting it would amount to medical error [7]. Dyspnoea assessment is challenging in intubated patients. The Mechanical Ventilation–Respiratory Distress Observation Scale could be of major clinical relevance, making breathing comfort evaluation possible in critically ill, noncommunicative patients. http://ow.ly/nhwx30lL13Q