Underdetection and Undertreatment of Dyspnea in Critically Ill Patients.

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Underdetection and Undertreatment of Dyspnea in Critically Ill Patients.

Am J Respir Crit Care Med. 2018 Nov 28;:

Authors: Gentzler ER, Derry H, Ouyang DJ, Lief L, Berlin DA, Xu CJ, Maciejewski PK, Prigerson HG

Rationale Dyspnea is a common and distressing physical symptom among patients in the intensive care unit, which may be underdetected and undertreated. Objective To determine the frequency of dyspnea relative to pain, the accuracy of nurses and personal caregiver dyspnea ratings relative to patient-reported dyspnea, and the relationship between nurse-detected dyspnea and treatment. Methods An observational study of patients (n=138) hospitalized in a medical intensive care unit (MICU). Nurses and patients' personal caregivers at the bedside reported on their perception of patients' symptoms. Measurements and Main Results Dyspnea was assessed by patients, caregivers, and nurses with a numerical rating scale. Across all three raters, the frequency of moderate-to-severe dyspnea was similar or greater than that of pain (p < .05 for caregiver and nurse ratings). Personal caregivers' ratings of dyspnea had substantial agreement with patient ratings ( = 0.65, p <0.001), but nurses' ratings were not significantly related to patient ratings ( = 0.19, p = 0.39). Nurse detection of moderate-to-severe pain was significantly associated with opioid treatment (OR = 2.70, 95% CI = 1.10 to 6.60, p = 0.03); however, nurse detection of moderate-to-severe dyspnea was not significantly associated with any assessed treatment. Conclusions Dyspnea was reported at least as frequently as pain among the sampled MICU patients. Personal caregivers had good agreement with patient reports of moderate-to-severe dyspnea. However, even when detected by nurses, dyspnea appeared to be undertreated. These findings suggest the need for improved detection and treatment of dyspnea in the MICU.

PMID: 30485121 [PubMed - as supplied by publisher]

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