Guidelines for the Initial Assessment of Respiratory Distress in the Emergency Department - 20/01/26

Doi : 10.1016/j.aicoj.2025.100005

P. Le Borgne ^a,⁎ , A.W. Thille ^b, J. Guenezan ^c, N. Aissaoui ^d, A.-S. Boureau ^e, C. Bally ^f, F. Balen ^g, A. Basset ^h, P. Bilbault ^a, F. Boissier ^b, Y.-E. Claessens ⁱ, M. Decavèle ^j, J.-L. Diehl ^k, D. Douillet ^l, A. Guillon ^m, P. Hausfater ⁿ, F. Javaudin ^o, M. Jezequel ^p, K. Kuteifan ^q, E. L’Her ^r, N. Marjanovic ^c, E. Maury ^s, M. Ohana ^t, C. Pichereau ^u, P. Ray ^v, P.-G. Reuter ^w, N. Tiberti ^x, G. Voiriot ^y, Y. Yordanov ^z, P. Le Conte ^o, N. Terzi ^aa

^a Université de Strasbourg, Service des Urgences, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France

^b Université de Poitiers, Service de Médecine Intensive Réanimation, CHU de Poitiers, F- 86000 Poitiers, France

^c Université de Poitiers, Service des Urgences, SAMU, SMUR, CHU de Poitiers; Faculté de Médecine et de Pharmacie, F- 86000 Poitiers, France

^d Université Paris Cité, Service de Cardiologie, Hôpitaux Européens Georges Pompidou, AP-HP, F-75010 Paris, France

^e Université de Nantes, Pole de Gérontologie Clinique, CHU Nantes, F-44000 Nantes, France

^f Service de Réanimation polyvalente/USC/Déchocage, Centre Hospitalier Annecy Genevois, F74000 Annecy, France

^g Université Toulouse III, Pôle de Médecine d'Urgence, CHU Toulouse, F-31000 Toulouse, France

^h Département de Médecine d'Urgence, CHRU Brest, F-29200 Brest, France

ⁱ Département de Médecine d'Urgence, Centre Hospitalier Princesse Grace, MC-98002, Monaco

^j Sorbonne Université, Service de Médecine Intensive - Réanimation (Département R3S), Site Pitié-Salpêtrière, AP-HP, F-75010 Paris, France

^k Université Paris Cité, Service de Médecine Intensive Réanimation, Hôpitaux Européens Georges Pompidou, AP-HP, F-75010 Paris, France

^l Université d’Angers, Département de Médecine d’Urgence, CHU Angers, F-49100, Angers, France

^m Université de Tours, Service de Médecine Intensive Réanimation, CHU Tours, F-37000, Tours, France

ⁿ Sorbonne Université, Service des Urgences, APHP-Sorbonne Université, Site Pitié-Salpêtrière, AP-HP, F-75010 Paris, France

^o Université de Nantes, Service des Urgences, CHU de Nantes, F-44000 Nantes, France

^p Service de Réanimation Médicale, Centre Hospitalier de St Brieuc, F-22000 St Brieuc, France

^q Service de Réanimation Médicale, GHRMSA, Hôpital Emile Muller, F-68100 Mulhouse, France

^r Université de Brest, Service de Médecine Intensive et de Réanimation, CHRU de Brest, F-29200 Brest, France

^s Sorbonne Université, Service de Médecine Intensive et de Réanimation, Hôpital Saint-Antoine, AP-HP, F-75571 Paris, France

^t Service de Radiologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France

^u Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Poissy Saint Germain, F-78300, Poissy, France

^v Département Universitaire de Médecine d’Urgence, Université Bourgogne Europe, CHU de Dijon, Dijon, France

^w Université de Rennes, Service SAMU 35/SMUR/Urgences Adultes, CHU Rennes, F-35000 Rennes, France

^x Aix-Marseille Université, Structure des Urgences, Centre Hospitalier Intercommunal Aix-Pertuis, F-13616 Aix-en-Provence, France

^y Sorbonne Université, Service de Médecine Intensive Réanimation, Hôpital Tenon, AP-HP, F-75020 Paris, France

^z Université de Lyon, Service des Urgences-SAMU 69, Hôpital Edouard Herriot, HCL, F-69001 Lyon, France

^aa Université de Rennes, Service de Médecine Intensive - Réanimation, CHU de Rennes, F-35033, Rennes, France

^⁎ Corresponding author.

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Abstract

Objective

The French Society of Emergency Medicine (SFMU) and the French Intensive Care Society (SRLF) present formalized expert recommendations from a multidisciplinary panel on the initial assessment of respiratory distress in adult patients presenting to the Emergency Department.

Design

A group of 30 French experts from the SFMU and FICS was assembled. Any potential conflicts of interest were officially declared at the start of the guidelines development process, which was conducted independently of any industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology to assess the level of evidence from the literature.

Methods

The aim of this expert panel was to define evidence-based recommendations for the initial assessment of respiratory distress in the emergency setting. Three key areas were defined: (1) assessment of severity in respiratory distress; (2) initial assessment and triage in respiratory distress; (3) diagnostic approach for respiratory distress. For each area, the goal of the recommendations was to address a set of questions formulated by the experts following the PICO model (“Population, Intervention, Comparison, Outcome”). Based on these questions, a comprehensive literature search was conducted for the last 20 years using predefined keywords according to PRISMA guidelines. The quality of the data was analyzed using the GRADE method. The recommendations were formulated using the GRADE methodology, and then voted on by all experts using the GRADE Grid method.

Results

The expert consensus process, based on the GRADE methodology, resulted in 13 clinical questions yielding 20 recommendations. For three of these questions, however, no recommendation could be issued due to insufficient evidence. After two rounds of voting and several amendments, a strong consensus was reached on the recommendations. Among these, two were supported by high-quality evidence and resulted in a strong recommendation (GRADE 1); six were based on moderate-quality evidence and led to a conditional recommendation (GRADE 2); and twelve were based on expert opinion, reflecting a low level of evidence. Finally, for 3 questions, no recommendation could be formulated.

Conclusion

A strong consensus was reached among the experts on 20 of the recommendations. This work provides updated recommendations for the initial assessment of respiratory distress in adult patients presenting to the Emergency Department.

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Keywords : Respiratory distress, Dyspnea, Triage, Acute respiratory failure, Emergency department, Severity assessment