Guidelines for the Initial Assessment of Respiratory Distress in the Emergency Department

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.

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.

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.

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.

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.