Dyspnea under mechanical ventilatory support

Abstract

Intensive care unit (ICU) patients are continuously exposed to various unpleasant sensations that are sources of discomfort. Growing attention has been given to the detection and treatment of pain, but not yet to dyspnea. However, growing evidence suggests that dyspnea is frequent and severe in mechanically ventilated ICU patients. Various evidences suggest that dyspnea contributes to make ICU stay a traumatizing experience and also to the genesis of posttraumatic stress disorders. In addition, dyspnea seems to be associated with longer durations of mechanical ventilation. In mechanically ventilated ICU patients, dyspnea is independently associated with anxiety and mechanical ventilation itself. Optimization of ventilator settings alleviates dyspnea, at least in 35% of the patients. Taken together, these data suggest that dyspnea should be monitored on a regular basis in mechanically ventilated patients. Large multicenter studies are needed to determine the prevalence of dyspnea in mechanically ventilated patients and to delineate its clinical consequences. The impact of strategies aiming at reducing dyspnea should also be evaluated.