Respiratory distress: a model of responses and behaviors to an asphyxial threat for patients who are unable to self-report.

Respiratory distress is the suffering that results from asphyxiation, and is characterized by observable behaviors. Standard measures of dyspnea rely on the patient's ability to self-report. However, not all patients who experience dyspnea are able to self-report because of temporary impairments or declining cognition, making them vulnerable to under-recognition and undertreatment of their distress. Hence, there is a need for a multidimensional behavioral assessment of respiratory distress. A synthesis of scientific literature contributed to the development of this model of respiratory distress behaviors. The proposed model relies on primitive, subcortical, emotional, and autonomic neurologic systems that are rapidly triggered in response to an asphyxial threat to sustain survival. The near-immediate activation of autonomic and fear responses from subcortical brain areas produces observable and measurable behaviors. This proposed model has clinical and scientific usefulness, if testing characterizes and confirms one or more patterns of patient behaviors, in response to an asphyxial threat.