Sensory and Emotional Modulation of Dyspnea Under Artificial Ventilation in the Intensive Care Unit

Summary

Participation Requirements

Description

Dyspnea or "shortness of breath" is a major symptom that alters the quality of life of patients who suffer from it. It is a multimodal sensation that integrates psychological, social and environmental factors (1). Recent studies have shown that dyspnea and pain share a number of characteristics (2)....

Dyspnea or "shortness of breath" is a major symptom that alters the quality of life of patients who suffer from it. It is a multimodal sensation that integrates psychological, social and environmental factors (1). Recent studies have shown that dyspnea and pain share a number of characteristics (2). In intensive care, dyspnea affects up to half of the patients under mechanical ventilation (3). However, unlike pain, which has been the subject of numerous studies in intensive care, relieving it is not a usual therapeutic objective. In recent years, despite considerable progress in the understanding of the mechanisms of dyspnea, there has been no major advance in the therapeutic tools aimed at relieving it. The best evaluated and most prescribed drugs currently available to relieve dyspnea are morphine drugs (4). However, there is no formal proof of their long-term effectiveness and side effects such as the respiratory depressant effect make them difficult to use. Non-pharmacological tools integrating the sensory but also emotional dimension of dyspnea have also been developed. The investigators find parallel medicines (acupuncture, hypnosis...) but also extra respiratory stimulation techniques (thoracic vibrations, administration of fresh air to the face...) which modulate and relieve dyspnea with a certain success (1). Optimizing tools to relieve dyspnea patients is therefore a priority. To date, the pharmacological arsenal is limited due to the number of effective molecules and their side effects. Non-pharmacological tools allowing to modulate the sensory and emotional components of dyspnea represent a therapeutic alternative that deserves to be explored. This is the purpose of this project. Half of the patients undergoing mechanical ventilation in intensive care have moderate to severe dyspnea. This dyspnea has a negative impact on the duration of mechanical ventilation, on patient comfort and on the incidence of post-traumatic stress disorder. Changing ventilation parameters does not always relieve dyspnea, and administering morphine prolongs the duration of mechanical ventilation. The possibility of distracting the patients' attention or modulating their emotions in order to relieve their dyspnea seems to be a simple way to improve their comfort and could represent an innovative therapeutic alternative. In this context, the investigators hypothesize that pleasant extra respiratory sensory stimulation relieves dyspnea in artificially ventilated patients without any change in ventilator settings and pharmacological intervention. The main objective of our study is to demonstrate, in dyspneic patients undergoing artificial ventilation, a decrease in dyspnea under the effect of : listening to a piece of music versus pink noise; the application of cold air to the face versus the application of cold air to the calf. The secondary objectives are to evaluate the effect of extra-respiratory stimuli on : the quality of dyspnea (thirst for air, excessive respiratory work, concentration) the intensity of secondary emotional responses (anxiety, fear). the electromyographic activity of extra-diaphragmatic inspiratory muscles STUDY CONDITIONS The experimental sessions will take place in the patient's room, in the Intensive Care Unit of Prof. T. Similowski. Patients will have been previously informed orally and in writing and will have signed the informed consent. TYPE OF STUDY It is research involving the human person with minimal risk and constraints, interventional, open, randomized. POPULATION, SAMPLING All subjects, without exception, must understand French and have read and understood the appropriate information leaflet and signed the consent form. It is research involving the human person with minimal risk and constraints, interventional, open, randomized. PATIENT MONITORING During the experimental sessions, an investigating physician will systematically be present in the room. Any tolerance abnormality (agitation, disturbance of vigilance, SpO2 <88%, tachycardia greater than 130/min or mean blood pressure < 60mmHG) will lead to the interruption of the experimental session. EXPERIMENTAL PROTOCOL Each patient will participate in a single one-hour experimental session that will take place as follows. The type of stimulation administered to the patient will be determined by randomization. The order of administration of the stimulation and its control will also be determined by randomization. Each experimental session will consist of ten sequences of 10 minutes each. The experimental sequences will proceed as follows: BASIC: recording of ventilation parameters, constants, ECG, skin conductance and psycho-sensory parameters at baseline. PRESSURE SUPPORT INCREMENT: An pressure support (+5) increment will be performed to ensure comparability of subsequent experimental sequences and their effect on dyspnea. WASH OUT: new recording in basic ventilation. Sensory and psycho-sensory parameters are again collected as above. STIMULUS 1 case or control: administration of extra-respiratory stimulation 1 or its control depending on the randomization arm. Sensory and psycho-sensory variables are measured as above. WASH OUT: new recording in basic ventilation. Sensory and psycho-sensory parameters are again collected as above. STIMULUS 1 case or control: administration of extra-respiratory stimulation 1 or its control according to the randomization arm. Sensory and psycho-sensory variables are measured as above. WASH OUT: new recording in basic ventilation. Sensory and psycho-sensory parameters are again collected as above. STIMULUS 2 cases or control: administration of extra respiratory stimulation 1 or its control according to the randomization arm. Sensory and psycho-sensory variables are measured as above. WASH OUT: new recording in basic ventilation. Sensory and psycho-sensory parameters are again collected as above. STIMULUS 2 cases or control: administration of extra respiratory stimulation 1 or its control according to the randomization arm. Sensory and psycho-sensory variables are measured as above. RECOVERY: Interruption of the stimulation or its control is interrupted. Recording of ventilatory, sensory and psycho-sensory parameters after return to baseline.

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