Assistance Publique-Hôpitaux de Paris, Service de Pneumologie et Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Crit Care Med. 2011 Sep;39(9):2059-65. doi: 10.1097/CCM.0b013e31821e8779.
Ensuring the comfort of intensive care unit patients is crucial. Although control of pain has been extensively addressed in this setting, data on dyspnea in mechanically ventilated patients are scant. The objective of this study was to assess the prevalence of dyspnea in mechanically ventilated patients, identify its clinical correlates, and examine its impact on clinical outcomes.
Prospective 6-month observational study.
Two medical intensive care units within university hospitals.
Intubated or tracheotomized patients who were mechanically ventilated for >24 hrs. We enrolled 96 patients (age, 61 ± 18 yrs; Simplified Acute Physiology Score II 43 [interquartile range, 31-60]) as soon as they could answer symptom-related questions. Dyspnea was evaluated on a "yes-no" basis; if yes, it was followed by a visual analog scale and descriptor choice ("air hunger" and/or "respiratory effort"). Pain and anxiety were also assessed by visual analog scales.
Ventilator settings adjustment in dyspneic patients.
Forty-five patients (47%) reported dyspnea (respiratory effort in seven cases, air hunger in 15, both in 16, and neither of these in seven). Dyspneic and nondyspneic patients did not differ in terms of age, Simplified Acute Physiology Score II, indication for mechanical ventilation, respiratory rate, clinical examination, chest radiograph, or blood gases. Dyspnea was significantly associated with anxiety (odd ratio [OR], 8.84; 95% confidence interval [CI], 3.26-24.0), assist-control ventilation (OR, 4.77; 95% CI, 1.60-4.3), and heart rate (OR, 1.33 per 10 beats/min; 95% CI, 1.02-1.75). Adjusting ventilator settings improved dyspnea in 35% of patients. Successful extubation within 3 days was significantly less frequent in patients whose dyspnea failed to recede after adjusting ventilator settings (five [17%] vs. 27 [40%]; p = .034).
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.
确保重症监护病房患者的舒适度至关重要。尽管在该环境中已经广泛关注疼痛的控制，但机械通气患者的呼吸困难数据却很少。本研究的目的是评估机械通气患者呼吸困难的发生率，确定其临床相关性，并研究其对临床结果的影响。
前瞻性 6 个月观察性研究。
两所大学附属医院的 2 个内科重症监护病房。
气管插管或气管切开的患者，他们接受机械通气时间超过 24 小时。一旦患者能够回答与症状相关的问题，我们就招募了 96 名患者（年龄 61 ± 18 岁；简化急性生理学评分 II 43 [四分位距，31-60]）。通过“是/否”来评估呼吸困难；如果是，接下来会进行视觉模拟评分和描述符选择（“空气饥饿”和/或“呼吸努力”）。还通过视觉模拟评分评估疼痛和焦虑。
调整呼吸困难患者的呼吸机设置。
45 名患者（47%）报告有呼吸困难（7 例呼吸用力，15 例空气饥饿，16 例两者均有，7 例两者均无）。呼吸困难和非呼吸困难患者在年龄、简化急性生理学评分 II、机械通气指征、呼吸频率、临床检查、胸部 X 线和血气方面没有差异。呼吸困难与焦虑显著相关（比值比 [OR]，8.84；95%置信区间 [CI]，3.26-24.0）、辅助控制通气（OR，4.77；95% CI，1.60-4.3）和心率（OR，每分钟增加 10 次心跳增加 1.33；95% CI，1.02-1.75）。调整呼吸机设置可使 35%的患者呼吸困难得到改善。调整呼吸机设置后呼吸困难未缓解的患者，3 天内成功拔管的比例明显较低（5[17%]例 vs. 27[40%]例；p =.034）。
机械通气患者呼吸困难频繁、强烈，与焦虑密切相关。它对呼吸机设置敏感，似乎与延迟拔管有关。
