ICU clinicians underestimate breathing discomfort in ventilated subjects

Abstract

BACKGROUND: Breathing discomfort (dyspnea) during mechanical ventilation in the ICU may contribute to patient distress and complicate care. Assessment of nonverbal cues may allow caregivers to estimate patient breathing discomfort. This study assesses the accuracy of those caregiver estimates. METHODS: Thirty subjects were identified from ventilated, hemodynamically stable patients in the special care unit of Maine Medical Center. Those with impaired neurological function or too unstable to waken were excluded. Subjects provided a subjective score of breathing discomfort (0–10 using a modified Borg scale) during daily wake-up from sedation (sedation-agitation score of 3 or 4). Clinicians (physicians, respiratory therapists, and nurses) then provided a blinded estimate of subject breathing discomfort (0–10) through observation of the subject and inspection of ventilator parameters alone. Subject scores and caregiver estimates were compared. RESULTS: All subjects reported breathing discomfort with median score (interquartile range) of 4 (3–4). Caregiver estimates of breathing discomfort were significantly lower than subject scores (2 [0–3]), and the discrepancy was seen in all professions (physicians 1 point lower [0–2], P =.02; respiratory therapists 1 point lower [0–2], P =.01; nurses 2 points lower [1–3], P