From the Guidelines
Open mouth breathing in an Intensive Care Unit (ICU) patient with sepsis is a sign of concern that warrants close monitoring and potential intervention.
Key Considerations
- The patient's airway should be kept clear, and unconscious patients should be placed in the lateral position to prevent aspiration [ 1 ].
- Non-invasive ventilation (NIV) may be considered in patients with dyspnea and/or persistent hypoxemia despite oxygen therapy, but a low threshold for airway intubation should be maintained [ 1 ].
- Patients with sepsis-induced acute respiratory distress syndrome (ARDS) who are responsive to relatively low levels of pressure support and positive end-expiratory pressure (PEEP) with stable hemodynamics may be candidates for NIV [ 1 ].
Clinical Implications
- Open mouth breathing may indicate respiratory distress or inability to clear the airway, which can lead to complications such as aspiration or pneumonia [ 1 ].
- Close monitoring of the patient's oxygen saturation and respiratory status is essential, and oxygen therapy should be administered to achieve an oxygen saturation of at least 90% [ 1 ].
- A weaning protocol should be in place for mechanically ventilated patients with severe sepsis, and spontaneous breathing trials should be performed regularly [ 1 ].
From the Research
Sepsis and Respiratory Failure
- Sepsis is a common cause of acute respiratory failure in ICU patients, often requiring invasive and non-invasive ventilation 2, 3.
- The development of a ventilatory strategy that achieves adequate oxygenation without injuring the lungs is crucial for patients with sepsis 3.
Breathing Patterns in Sepsis
- Patients with sepsis tend to breathe with a higher respiratory rate:tidal volume ratio (RVR) and may have a lower maximal inspiratory pressure (MIP) compared to those without sepsis 4.
- This altered breathing pattern may be associated with a higher risk of weaning failure and longer duration of mechanical ventilation 4.
Oral Care and Open Mouth Breathing
- While there is no direct evidence linking open mouth breathing to sepsis in ICU patients, oral care is an important aspect of ICU management, and patients with sepsis may have significant oral health needs 5.
- However, the available studies do not specifically address open mouth breathing as a sign of concern in ICU patients with sepsis.
Clinical Implications
- Clinicians should be aware of the potential for altered breathing patterns in patients with sepsis and monitor their respiratory status closely 4.
- Further research is needed to fully understand the relationship between sepsis, respiratory failure, and oral care in ICU patients.