Photo Credit: Thanakorn Piadaeng

The following is a summary of “Dyspnea is severe and associated with a higher intubation rate in de novo acute hypoxemic respiratory failure,” published in the May 2024 issue of Critical Care by Demoule et al.

Dyspnea is a common sign in people with sudden critically low blood oxygen de novo acute hypoxemic respiratory failure.

Researchers conducted a retrospective study to evaluate whether dyspnea predicts the need for intubation and mortality in patients with de novo acute hypoxemic respiratory failure.

They conducted a secondary analysis of a multicenter, randomized, controlled trial. Dyspnea was assessed using a visual analog scale (dyspnea-VAS) ranging from zero to 100 mm and was evaluated in 259/310 patients enrolled. Factors influencing intubation were examined using a competing risks model considering ICU discharge. The Cox model analyzed factors affecting 90-day mortality.

The results showed that at baseline (randomization in the parent trial), the median dyspnea-VAS was 46 (IQR, 16–65) mm, with ≥40 mm in 146 patients (56%). The intubation rate was 45%. Moderate (dyspnea-VAS 40–64 mm) and severe (dyspnea-VAS ≥65 mm) dyspnea at baseline, systolic arterial pressure, heart rate, and PaO²/FiO² were independently associated with intubation (sHR 1.96, 2.61, 2.56, 1.94, 0.34, respectively). The 90-day mortality stood at 20%, and patients with baseline dyspnea-VAS ≥40 mm had a lower cumulative probability of survival (log-rank test, P=0.049). Variables independently associated with mortality were SAPS 2 ≥25, moderate-to-severe dyspnea at baseline, PaO²/FiO², and treatment arm.

Investigators concluded that patients in ICU with de novo acute hypoxemic respiratory failure experienced dyspnea, were more likely to require intubation, and had a higher risk of death.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04903-5