Dyspnea and Respiratory Distress in the Neuro ICU

Dyspnea, a sensation of breathlessness, is a common occurrence in the intensive care unit. The differential diagnosis of dyspnea is innumerable and can be related to multiple organ systems. The clinical importance of recognizing and evaluating dyspnea is that it can be a harbinger of acute respiratory decompensation and potential cardiopulmonary collapse. For patients in the neurological and neurosurgical ICU, underlying neurological diseases can make them more prone to dyspnea and respiratory distress. Respiratory distress and concomitant respiratory failure can be due to various factors causing problems with oxygenation and ventilation. The biomechanics and neurochemical regulation of breathing is a complex system. Patients in the neuro ICU can suffer from disease processes affecting one or multiple aspects of the respiratory system, that is, central or peripheral neurological regulation of respiration, respiratory muscle weakness, or primary lung pathology. Altered mentation and bulbar dysfunction cause high secretion burdens and potential aspiration pneumonia. Neurogenic pulmonary edema and neuromuscular diseases in patients in the neuro ICU also contribute to the risk of respiratory failure. Understanding the role of early and deliberate use of noninvasive ventilatory support such as high-flow nasal cannula and BiPAP to improve oxygenation and ventilation can stabilize patients and prevent further decompensation. Frequent reassessment of patients at risk for respiratory failure and timely initiation of invasive ventilation remains the hallmark of successful management.