Dyspnea, Acute Respiratory Failure, Psychological Trauma, and Post-ICU Mental Health: A Caution and a Call for Research.
Dyspnea, Acute Respiratory Failure, Psychological Trauma, and Post-ICU Mental Health: A Caution and a Call for Research.
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DOI：
10.1016/j.chest.2020.09.251
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发表时间：
2021-03
期刊：
影响因子：
9.6
通讯作者：
Schwartzstein RM
中科院分区：
文献类型：
--
作者：
Worsham CM;Banzett RB;Schwartzstein RM
呼吸困难是一种不舒服的感觉，有可能导致心理创伤。出现急性呼吸衰竭的患者，特别是在机械通气期间潮气量受限时，可能会出现最令人痛苦的呼吸困难形式，称为空气饥饿。空气饥饿会激活已知与创伤后应激障碍（PTSD）、焦虑和抑郁有关的大脑通路。这些情况被认为是重症监护后综合征的一部分。这些后遗症在ARDS患者中可能更为普遍。低潮气量是现代治疗ARDS的主要手段，但这是难以避免的，尽管有镇静作用，仍可能引起空气饥饿。辅助性神经肌肉阻滞不能预防或缓解空气饥饿，但可以防止患者将不适传达给护理人员。因此，瘫痪也可能导致PTSD的发展。尽管研究已经确定ARDS后PTSD是引起关注的原因，并且研究人员已经采取措施量化疾病负担，但很少有信息指导旨在减少其发生的机械通气策略。我们认为，如果这些努力是针对已知的空气饥饿机制，那么它们将更加成功。调查ICU常用的镇静和镇痛药物的抗呼吸困难作用及其对ARDS后PTSD症状的影响是合乎逻辑的下一步。虽然在实践中，我们经常接受挽救生命的治疗的负面后果是不可避免的，但我们必须了解我们的治疗的负面后果，并根据我们的主要指令“首先，不要伤害”患者，努力将其减少到最低限度。
Dyspnea is an uncomfortable sensation with the potential to cause psychological trauma. Patients presenting with acute respiratory failure, particularly when tidal volume is restricted during mechanical ventilation, may experience the most distressing form of dyspnea known as air hunger. Air hunger activates brain pathways known to be involved in posttraumatic stress disorder (PTSD), anxiety, and depression. These conditions are considered part of the post-intensive care syndrome. These sequelae may be even more prevalent among patients with ARDS. Low tidal volume, a mainstay of modern therapy for ARDS, is difficult to avoid and is likely to cause air hunger despite sedation. Adjunctive neuromuscular blockade does not prevent or relieve air hunger, but it does prevent the patient from communicating discomfort to caregivers. Consequently, paralysis may also contribute to the development of PTSD. Although research has identified post-ARDS PTSD as a cause for concern, and investigators have taken steps to quantify the burden of disease, there is little information to guide mechanical ventilation strategies designed to reduce its occurrence. We suggest such efforts will be more successful if they are directed at the known mechanisms of air hunger. Investigation of the antidyspnea effects of sedative and analgesic drugs commonly used in the ICU and their impact on post-ARDS PTSD symptoms is a logical next step. Although in practice we often accept negative consequences of life-saving therapies as unavoidable, we must understand the negative sequelae of our therapies and work to minimize them under our primary directive to “first, do no harm” to patients.
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