CHEST Guidelines-Response

Response_chest (20)

Pdf Summary

The correspondence is a response to a letter regarding a review on dyspnea management in critically and terminally ill patients, especially those who cannot communicate effectively due to impaired cognition or communication issues. The letter points out that fewer than 10% of the studies in the review focused on conditions like Acute Respiratory Distress Syndrome (ARDS) or respiratory failure, which are frequently associated with impaired sensorium. The importance of evaluating dyspnea in noncommunicative patients is emphasized, an area not extensively covered in the review. The letter introduces the Intensive Care-Respiratory Distress Observation Scale (IC-RDOS), designed to assess respiratory distress in noncommunicative ICU patients. This scale uses variables such as supplemental oxygen use, facial expressions of fear, heart rate, and muscle use to assess distress but may not be specific to respiratory distress as other factors like pain intensity, sedation levels, and clinical state might influence these variables. Although initial studies show a good correlation between IC-RDOS and self-reported dyspnea on a visual analog scale in communicative patients, further evaluation is needed to validate it for noncommunicative patients. The authors of the response express gratitude to the letter's authors for highlighting the significance of evaluation tools for dyspnea management in the ICU. They acknowledge the need for more studies to confirm if the IC-RDOS can lead to effective interventions for noncommunicative patients. The response aims to further research into nonpharmacological and pharmacological interventions for ameliorating symptoms based on such observational scales.

Keywords

dyspnea management

noncommunicative patients

ICU

IC-RDOS

respiratory distress

Acute Respiratory Distress Syndrome

respiratory failure

cognition impairment

evaluation tools

nonpharmacological interventions