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Review
. 2023 Aug;18(5):1491-1507.
doi: 10.1007/s11739-023-03322-8. Epub 2023 Jun 2.

Acute dyspnea in the emergency department: a clinical review

Pierachille Santus  1   2 , Dejan Radovanovic  3   4 , Marina Saad  3 , Camilla Zilianti  5 , Silvia Coppola  6 , Davide Alberto Chiumello  6   7   8 , Matteo Pecchiari  5
Affiliations
Review

Acute dyspnea in the emergency department: a clinical review

Pierachille Santus et al. Intern Emerg Med. 2023 Aug.

Abstract

Acute dyspnea represents one of the most frequent symptoms leading to emergency room evaluation. Its significant prognostic value warrants a careful evaluation. The differential diagnosis of dyspnea is complex due to the lack of specificity and the loose association between its intensity and the severity of the underlying pathological condition. The initial assessment of dyspnea calls for prompt diagnostic evaluation and identification of optimal monitoring strategy and provides information useful to allocate the patient to the most appropriate setting of care. In recent years, accumulating evidence indicated that lung ultrasound, along with echocardiography, represents the first rapid and non-invasive line of assessment that accurately differentiates heart, lung or extra-pulmonary involvement in patients with dyspnea. Moreover, non-invasive respiratory support modalities such as high-flow nasal oxygen and continuous positive airway pressure have aroused major clinical interest, in light of their efficacy and practicality to treat patients with dyspnea requiring ventilatory support, without using invasive mechanical ventilation. This clinical review is focused on the pathophysiology of acute dyspnea, on its clinical presentation and evaluation, including ultrasound-based diagnostic workup, and on available non-invasive modalities of respiratory support that may be required in patients with acute dyspnea secondary or associated with respiratory failure.

Keywords: Cardiogenic edema; Dyspnea; High flow oxygen; Non-invasive ventilation; Respiratory failure; Respiratory support.

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Conflict of interest statement

The authors declare that they have no conflict of interest in regard to the submitted work.

Figures

Fig. 1
Fig. 1
Main normal and pathological findings during lung ultrasound
Fig. 2
Fig. 2
Summary of the diagnostic workup in patients with acute dyspnea presenting at the emergency department. BNP: B type natriuretic peptide; NT-proBNP: N-terminal pro B-type natriuretic peptide; hs-cTn: high sensitivity cardiac troponin; CT: computed tomography; PaO2: arterial partial pressure of oxygen; PaCO2: arterial partial pressure of carbon dioxide; HCO3−: bicarbonate
See this image and copyright information in PMC

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