Decavèle Maxens, Bureau Côme, Campion Sébastien, Nierat Marie-Cécile, Rivals Isabelle, Wattiez Nicolas, Faure Morgane, Mayaux Julien, Morawiec Elise, Raux Mathieu, Similowski Thomas, Demoule Alexandre
Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche en Santé 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.
Service de Médecine Intensive et Réanimation (Département R3S) and.
Am J Respir Crit Care Med. 2023 Jul 1;208(1):39-48. doi: 10.1164/rccm.202301-0188OC.
Breathing difficulties are highly stressful. In critically ill patients, they are associated with an increased risk of posttraumatic manifestations. Dyspnea, the corresponding symptom, cannot be directly assessed in noncommunicative patients. This difficulty can be circumvented using observation scales such as the mechanical ventilation-respiratory distress observation scale (MV-RDOS). To investigate the performance and responsiveness of the MV-RDOS to infer dyspnea in noncommunicative intubated patients. Communicative and noncommunicative patients exhibiting breathing difficulties under mechanical ventilation were prospectively included and assessed using a dyspnea visual analog scale, MV-RDOS, EMG activity of alae nasi and parasternal intercostals, and EEG signatures of respiratory-related cortical activation (preinspiratory potentials). Inspiratory-muscle EMG and preinspiratory cortical activities are surrogates of dyspnea. Assessments were conducted at baseline, after adjustment of ventilator settings, and, in some cases, after morphine administration. Fifty patients (age, 67 [(interquartile interval [IQR]), 61-76] yr; Simplified Acute Physiology Score II, 52 [IQR, 35-62]) were included, 25 of whom were noncommunicative. Relief occurred in 25 (50%) patients after ventilator adjustments and in 21 additional patients after morphine administration. In noncommunicative patients, MV-RDOS score decreased from 5.5 (IQR, 4.2-6.6) at baseline to 4.2 (IQR, 2.1-4.7; < 0.001) after ventilator adjustments and 2.5 (IQR, 2.1-4.2; = 0.024) after morphine administration. MV-RDOS and alae nasi/parasternal EMG activities were positively correlated (ρ = 0.41 and 0.37, respectively). MV-RDOS scores were higher in patients with EEG preinspiratory potentials (4.9 [IQR, 4.2-6.3] vs. 4.0 [IQR, 2.1-4.9]; = 0.002). The MV-RDOS seems able to detect and monitor respiratory symptoms reasonably well in noncommunicative intubated patients. Clinical trial registered with www.clinicaltrials.gov (NCT02801838).
呼吸困难会带来极大的压力。在重症患者中，呼吸困难与创伤后表现风险增加相关。相应的症状——呼吸困难，在无法交流的患者中无法直接评估。使用诸如机械通气 - 呼吸窘迫观察量表（MV - RDOS）等观察量表可以规避这一困难。目的是研究MV - RDOS在推断非交流性插管患者呼吸困难方面的性能和反应性。前瞻性纳入了在机械通气下出现呼吸困难的交流性和非交流性患者，并使用呼吸困难视觉模拟量表、MV - RDOS、鼻翼和胸骨旁肋间肌的肌电图活动以及呼吸相关皮层激活的脑电图特征（吸气前电位）进行评估。吸气肌肌电图和吸气前皮层活动是呼吸困难的替代指标。评估在基线、调整呼吸机设置后以及在某些情况下吗啡给药后进行。纳入了50例患者（年龄67岁[四分位间距（IQR），61 - 76岁]；简化急性生理学评分II为52分[IQR，35 - 62分]），其中25例为非交流性患者。呼吸机调整后25例（50%）患者症状缓解，吗啡给药后又有21例患者症状缓解。在非交流性患者中，MV - RDOS评分从基线时的5.5（IQR，4.2 - 6.6）降至呼吸机调整后的4.2（IQR，2.1 - 4.7；P < 0.001），吗啡给药后降至2.5（IQR，2.1 - 4.2；P = 0.024）。MV - RDOS与鼻翼/胸骨旁肌电图活动呈正相关（分别为ρ = 0.41和0.37）。有脑电图吸气前电位的患者MV - RDOS评分更高（4.9[IQR，4.2 - 6.3]对4.0[IQR，2.1 - 4.9]；P = 0.002）。MV - RDOS似乎能够在非交流性插管患者中较好地检测和监测呼吸症状。在www.clinicaltrials.gov注册的临床试验（NCT02801838）。
