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Randomized Controlled Trial
. 2024 May 23;28(1):174.
doi: 10.1186/s13054-024-04903-5.

Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure

Alexandre Demoule  1   2 , Amandine Baptiste  3 , Arnaud W Thille  4   5 , Thomas Similowski  6   7 , Stephanie Ragot  5 , Gwénael Prat  8 , Alain Mercat  9 , Christophe Girault  10 , Guillaume Carteaux  11 , Thierry Boulain  12 , Sébastien Perbet  13   14 , Maxens Decavèle  6   15 , Lisa Belin  16 , Jean-Pierre Frat  4   5 ; from the REVA Network (Research Network in Mechanical Ventilation)
Affiliations
Randomized Controlled Trial

Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure

Alexandre Demoule et al. Crit Care. .

Erratum in

Abstract

Background: Dyspnea is a key symptom of de novo acute hypoxemic respiratory failure. This study explores dyspnea and its association with intubation and mortality in this population.

Methods: This was a secondary analysis of a multicenter, randomized, controlled trial. Dyspnea was quantified by a visual analog scale (dyspnea-VAS) from zero to 100 mm. Dyspnea was measured in 259 of the 310 patients included. Factors associated with intubation were assessed with a competing risks model taking into account ICU discharge. The Cox model was used to evaluate factors associated with 90-day mortality.

Results: At baseline (randomization in the parent trial), median dyspnea-VAS was 46 (interquartile range, 16-65) mm and was ≥ 40 mm in 146 patients (56%). The intubation rate was 45%. Baseline variables independently associated with intubation were moderate (dyspnea-VAS 40-64 mm) and severe (dyspnea-VAS ≥ 65 mm) dyspnea at baseline (sHR 1.96 and 2.61, p = 0.023), systolic arterial pressure (sHR 2.56, p < 0.001), heart rate (sHR 1.94, p = 0.02) and PaO2/FiO2 (sHR 0.34, p = 0.028). 90-day mortality was 20%. The cumulative probability of survival was lower in patients with baseline dyspnea-VAS ≥ 40 mm (logrank test, p = 0.049). Variables independently associated with mortality were SAPS 2 ≥ 25 (p < 0.001), moderate-to-severe dyspnea at baseline (p = 0.073), PaO2/FiO2 (p = 0.118), and treatment arm (p = 0.046).

Conclusions: In patients admitted to the ICU for de novo acute hypoxemic respiratory failure, dyspnea is associated with a higher risk of intubation and with a higher mortality.

Trial registration: clinicaltrials.gov Identifier # NCT01320384.

Keywords: Acute respiratory failure; Dyspnea; High-flow oxygen therapy; Intubation; Mortality.

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Conflict of interest statement

A Demoule reports grants from French Ministry of Health, Assistance publique—Hôpitaux de Paris, Lungpacer, Respinor, consulting fees from Respinor, Lungpacer, Lowenstein, Tribunal administrative de Cergy, Liberate Medical, Payment or honoraria for lectures, presentations from Fisher & Paykel, Baxter, Getinge, Astra, Agence Européenne Informatique, Mindray, support for attending meetings and/or travel from Lungpacer, outside the submitted work. A Baptiste has nothing to disclose. AW Thille reports payment or honoraria for lectures, presentations Fisher & Paykel, GE Healthcare, Philips, support for attending meetings and/or travel Fisher & Paykel, GE Healthcare, outside the submitted work. T Similowski reports grants from Lungpacer, consulting fees from ADEP Assistance, AstraZeneca France, Chiesi France, KPL consulting, Lungpacer Inc., Novartis France, TEVA France, Vitalaire, outside the submitted work. S Ragot has nothing to disclose G Prat has nothing to disclose A Mercat has nothing to disclose. C Girault reports payment or honoraria for lectures, presentations from Air Liquide Medical System, Medtronic, Dräger, support for attending meetings and/or travel from Fisher & Paykel, GE healthcare, Air Liquide Medical System, outside the submitted work. G Carteau reports payment or honoraria for lectures, presentations Air Liquide Medical System Medtronic Dräger, support for attending meetings and/or travel from Air Liquide Medical System outside the submitted work. T Boulain has nothing to disclose. S Perbet has nothing to disclose. L Belin has nothing to disclose. JP Frat reports non-financial support from Fisher and Paykel Healthcare (the firm provided material and equipment to all the participating centers), grant from the French Ministry of Heath, AADAIRC, French society of intensive care for the parent study, grants from the French Ministry of Heath, Fisher and Paykel Healthcare, consulting fees from SOS Oxygene, payment or honoraria for lectures from Fisher and Paykel Healthcare, support for attending meetings and/or travel from Fisher and Paykel Healthcare and SOS Oxygene, outside the submitted work.

Figures

Fig. 1
Fig. 1
Box plots showing dyspnea-visual analog scale from zero (no respiratory discomfort) to 100 mm (worst imaginable respiratory discomfort) at baseline and 1 h after treatment initiation. The black center line denotes the median value (50th percentile), while the box contains the 25th to 75th percentiles of dataset. The blue line denotes the mean value. The black whiskers mark the maximal and minimal values
Fig. 2
Fig. 2
Cumulative incidence of intubation (solid line) while accounting for intensive care unit discharge (dashed line) among patients with no dyspnea at baseline (blue line), mild dyspnea (red line), moderate dyspnea (black line) and severe dyspnea (green line)
Fig. 3
Fig. 3
Cumulative survival up to 90 days in patients with no dyspnea at baseline (blue line), mild dyspnea (red line), moderate dyspnea (black line) and severe dyspnea (green line)
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