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Dyspnoea in the critically ill 

Dyspnoea in the critically ill
Dyspnoea in the critically ill

Paolo Tarsia

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date: 23 February 2020

Dyspnoea may be defined as a subjective experience of discomfort associated with breathing. Breathing discomfort arises as a result of complex interactions between signals relayed from the upper airways, the chest wall, the lungs, and the central nervous system. Integration of this information with higher brain centres provides further processing. The final aspects of the sensation of dyspnoea are influenced by contextual, environmental, behavioural, and cognitive factors. At least three qualitatively distinct sensations have been employed to describe discomfort in breathing—air hunger, increased effort of breathing, and chest tightness. Air hunger has been shown to be associated with stimulation of chemoreceptors. Increased effort of breathing may arise in clinical conditions that impair respiratory muscle performance through abnormal mechanical loads or when respiratory muscles are weakened (neuromuscular diseases). Chest tightness is often experienced by asthmatic patients during episodes of acute bronchoconstriction. Measurement of dyspnoea is essential in order to assess it adequately and monitor response to treatment. Dyspnoea assessment may be carried out thorough a number of different scales, questionnaires, or exercise tests. Strategies in controlling dyspnoea should not focus uniquely on decreasing dyspnoea intensity. Patients may profit from interventions that decrease the unpleasantness associated with breathlessness without necessarily affecting the intensity component of the symptom.

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