No systematic investigation into dyspnea in patients receiving prolonged ventilation (>21 days) after recovering from critical-illness has been published. To determine magnitude, nature and pathophysiological basis of dyspnea during an unassisted-breathing trial in prolonged-ventilation patients. Dyspnea intensity and descriptor selection were investigated in 27 prolonged-ventilation patients during a 60-min unassisted-breathing trial. Pressure-time product (PTP), respiratory mechanics, and transcutaneous PCO2 (PtcCO2) were also measured. Of 10 patients who reported dyspnea during assist-control ventilation, 9 (90.0%) selected "Not getting enough air" to characterize dyspnea. Tidal-volume setting was lower in dyspneic than non-dyspneic patients: 480.0 versus 559.4 ml (p<0.046). During the unassisted-breathing trial (n=26), patients developed increases in dyspnea (p<0.01) and PtcCO2 (p<0.01), but no change in minute ventilation. Dyspnea score was strongly linked to PtcCO2 (p<0.012) and airway resistance (p<0.013) but not respiratory work (although PTP was almost 3 times higher than normal). At 60 min into the trial, 83.3% of patients selected "Not getting enough air" on its own or in combination with "Too much effort" to describe discomfort whereas only 16.7% selected "Too much effort" on its own (p<0.001). Across the dyspnea spectrum, patients chose "Not getting enough air" overwhelmingly over other descriptor options (p<0.001). Patients developed increases in dyspnea and PtcCO2 but unchanged minute ventilation and work of breathing during an unassisted-breathing trial; patients selected air-hunger descriptors overwhelmingly over excessive effort; the observations support the belief that air hunger results from heightened respiratory-center stimulation combined with incapacity to increase minute ventilation.
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