Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement.

This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society and the European Society of Intensive Care Medicine. Dyspnoea ranks among the most distressing experiences that human beings can endure. Approximately 40% of patients undergoing invasive mechanical ventilation in the intensive care unit (ICU) report dyspnoea, with an average intensity of 45 mm on a visual analogue scale from 0 to 100 mm. Although it shares many similarities with pain, dyspnoea can be far worse than pain in that it summons a primal fear response. As such, it merits universal and specific consideration. Dyspnoea must be identified, prevented and relieved in every patient. In the ICU, mechanically ventilated patients are at high risk of experiencing breathing difficulties because of their physiological status and, in some instances, because of mechanical ventilation itself. At the same time, mechanically ventilated patients have barriers to signalling their distress. Addressing this major clinical challenge mandates teaching and training, and involves ICU caregivers and patients. This is even more important because, as opposed to pain which has become a universal healthcare concern, very little attention has been paid to the identification and management of respiratory suffering in mechanically ventilated ICU patients.

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Déclaration de conflit d'intérêts

Conflict of interest: A. Demoule reports grants from Philips, the French Ministry of Health, Assistance Publique – Hôpitaux de Paris, Lungpacer and Respinor, consulting fees from Respinor, Lungpacer, Lowenstein, Tribunal administrative de Cergy and Liberate Medical, payment or honoraria for lectures and presentations from Fisher & Paykel, Baxter, Getinge, AstraZeneca, Agence Européenne Informatique and Mindray, and support for attending meetings and/or travel from Lungpacer, outside the submitted work. M. Decavele reports support for attending meetings and/or travel from Isis Medical, outside the submitted work. M. Antonelli reports grants from GE Health Care, Fisher & Paykel and Toray, payment or honoraria for lectures, presentations, manuscript writing or educational events from Shionogi, Pfizer, Chiesi and Menarini, participation on a data and safety monitoring board or advisory board for Menarini, and is Past President of the European Society of Intensive Care Medicine (ESICM), outside the submitted work. L. Camporota reports no conflict of interest. F. Abroug reports no conflict of interest. D. Adler reports no conflict of interest. E. Azoulay reports grants from Alexion, Karmatt, and MSD Avenir, payment or honoraria for lectures, presentations, manuscript writing or educational events from Gilead, GE Health Care (fees paid to research group), Alexion, Sanofi, Pfizer (to author) and Mindray (to hospital), participation on a data and safety monitoring board or advisory board for IQVIA, and receipt of isavuconazole from Pfizer for the trial Efraim 2. M. Basoglu reports no conflict of interest. M. Campbell reports no conflict of interest. G. Grasselli reports grants from Fisher & Paykel, payment or honoraria for lectures, presentations, manuscript writing or educational events from Draeger Medical, Fisher & Paykel, and Getinge, outside the submitted work. M. Herridge reports no conflict of interest. M.J. Johnson reports consulting for Mayne Pharma, outside the submitted work. L. Naccache reports no conflict of interest. P. Navalesi reports grants from Draeger, royalties or licenses from Intersurgical SPA, consulting fees from Mindray, payment or honoraria for lectures, presentations, manuscript writing or educational events from Getinge, Mindray, Draeger and Intersurgical, support for attending meetings and/or travel from Fisher & Paykel, patents planned, issued or pending from Intersurgical SPA, and receipt of equipment, materials, drugs, medical writing, gifts or other services from Mindray, Intersurgical SPA and Draeger, outside the submitted work. P. Pelosi reports no conflict of interest. R. Schwartzstein reports royalties from UpToDate, Inc. for medical writing contributions, outside the submitted work. C. Williams is an employee of the European Lung Foundation. W. Windisch reports grants from Lowenstein, Philips/Respironics and GCI Great Britain, consulting fees from BioNTech Europe GmbH, and payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Germany, Sentec, Switzerland, Chiesi, Germany, Boehringer Ingelheim, Germany, Novartis, Germany, BioNTech Europe GmbH and Philips/Respironics, USA, outside the submitted work. L. Heunks reports grants from ZonMw, ERS and Liberate Medical, consulting fees from Liberate Medical, and fees for role as Associate Editor from AJRCCM, outside the submitted work. T. Similowski reports consulting fees from AstraZeneca France, Chiesi France, KPL consulting, Lungpacer Inc. and OSO-AI France, payment or honoraria for lectures, presentations, manuscript writing or educational events from Chiesi France, Vitalaire France and TEVA France, patents planned, issued or pending WO2008006963A3, WO2012004534A1 and WO2013164462A1, and stock or stock options from Austral Dx and Hephai, outside the submitted work.