The Mechanical Ventilation–Respiratory Distress Observation Scale as a surrogate of self-reported dyspnoea in intubated patients

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