背景:重症监护病房(ICU)的成年人通常会出现令人痛苦的症状和其他问题,例如疼痛,谵妄,和呼吸困难。无呼吸管理不受任何ICU指南的支持,与其他症状不同。
目的:回顾与(i)患病率有关的文献,强度,评估,ICU中接受有创和无创机械通气(NIV)和高流量氧气疗法的危重成人的呼吸困难和管理,(HFOT),(ii)呼吸困难对ICU患者参与康复的影响。
方法:使用Cochrane方法组建议进行了快速回顾和叙述综合,并根据PRISMA进行了报告。所有研究设计均调查接受有创机械通气(IMV)的成年ICU患者的呼吸困难,NIV或HFOT符合资格。PubMed,MEDLINE,从2013年6月至2023年6月,搜索了Cochrane图书馆和CINAHL数据库。研究进行了质量评估。
结果:纳入了代表2822名ICU患者的19项研究(参与者平均年龄48岁至71岁;男性比例为43-100%)。接受IMV的ICU患者呼吸困难的加权平均患病率为49%(范围34-66%)。开始前接受NIV自我报告中度至重度呼吸困难的患者比例为55%。呼吸困难评估工具包括视觉模拟量表,(VAS),数字评级量表,(NRS)和修改后的BORG量表,(mBORG)。在接受NIV的患者中,报告的中位数(四分位距[IQR])VAS最高,NRS和mBORG评分为6.2cm(0-10cm),分别为5(2-7)和6(2.3-7)(中度至重度呼吸困难)。在接受NIV或HFOT的患者中,报告的中位数(IQR)VAS最高,NRS和mBORG评分为3厘米(0-6厘米),8(5-10)和4(3-5)。
结论:接受IMV的成年人呼吸困难,ICU中的NIV或HFOT很普遍,并且具有临床重要性,中位强度等级表明存在中度至重度症状。
BACKGROUND: Adults in the intensive care unit (ICU) commonly experience distressing symptoms and other concerns such as pain, delirium, and breathlessness. Breathlessness management is not supported by any ICU guidelines, unlike other symptoms.
OBJECTIVE: To review the literature relating to (i) prevalence, intensity, assessment, and management of breathlessness in critically ill adults in the ICU receiving invasive and non-invasive mechanical ventilation (NIV) and high-flow oxygen therapy, (HFOT), (ii) the impact of breathlessness on ICU patients with regard to engagement with rehabilitation.
METHODS: A rapid review and narrative synthesis using the Cochrane Methods Group Recommendations was conducted and reported in accordance with PRISMA. All study designs investigating breathlessness in adult ICU patients receiving either invasive mechanical ventilation (IMV), NIV or HFOT were eligible. PubMed, MEDLINE, The Cochrane Library and CINAHL databased were searched from June 2013 to June 2023. Studies were quality appraised.
RESULTS: 19 studies representing 2822 ICU patients were included (participants mean age 48 years to 71 years; proportion of males 43-100%). The weighted mean prevalence of breathlessness in ICU patients receiving IMV was 49% (range 34-66%). The proportion of patients receiving NIV self-reporting moderate to severe
dyspnoea was 55% prior to initiation. Breathlessness assessment tools included visual analogue scale, (VAS), numerical rating scale, (NRS) and modified BORG scale, (mBORG). In patients receiving NIV the highest reported median (interquartile range [IQR]) VAS, NRS and mBORG scores were 6.2cm (0-10 cm), 5 (2-7) and 6 (2.3-7) respectively (moderate to severe breathlessness). In patients receiving either NIV or HFOT the highest reported median (IQR) VAS, NRS and mBORG scores were 3 cm (0-6 cm), 8 (5-10) and 4 (3-5) respectively.
CONCLUSIONS: Breathlessness in adults receiving IMV, NIV or HFOT in the ICU is prevalent and clinically important with median intensity ratings indicating the presence of moderate to severe symptoms.