Response to “Relationships between dyspnea, oxygenation and prognosis in hypoxemic respiratory failure”

Abstract

We thank Dr Shen and Dr Ding [1] for their thorough reading of our manuscript [2] and for having pointed out mistakes in Tables 1 and 2 regarding the ratio of arterial oxygen tension to inspired oxygen fraction (PaO₂/FiO₂). These mistakes have been corrected [3]. Although there was a trend toward a lower PaO₂/FiO₂ in the most dyspneic patients, the association between dyspnea and PaO₂/FiO₂ was not significant. This is not surprising since this absence of significant link between PaO₂/FiO₂ has been previously reported in intubated patients [4, 5] and in patients receiving non-invasive ventilation for acute respiratory failure [6].

As pointed by Dr Shen and Dr Deng, many inputs and factors contribute to the pathogenesis of dyspnea [7], including respiratory system mechanics and low tidal volume or low level of inspiratory assist in mechanically ventilated patients [4, 5, 8]. There is also a strong association between anxiety and dyspnea [4, 5]. A high inspiratory dive is also associated with dyspnea [9]. Unfortunately, none of these factors has an excellent performance to predict dyspnea in non-communicative patients who cannot self-report dyspnea, reason why observational scales such as the mechanical ventilation—respiratory distress observation scale (MV-RDOS) have been developed to detect dyspnea in this population [10].

Finally, that moderate to severe dyspnea is associated with a higher rate of intubation is a fact [6]. The intubation making decision is complex and relies on many factors. As suggested by Dr Shen and Dr Deng, this decision should not been based on the sole level of dyspnea. However, it might be valuable to integrate the intensity of dyspnea in this decision making process. Future prospective trials may help addressing this important question.

No datasets were generated or analysed during the current study.

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Authors and Affiliations

1. UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, INSERM, 75005, Paris, France

   Alexandre Demoule & Maxens Decavèle

2. Service de Médecine Intensive - Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 47-83 Boulevard de L’Hôpital, 75013, Paris, France

   Alexandre Demoule & Maxens Decavèle

3. AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Unité de Recherche Clinique, Paris, France

   Amandine Baptiste

4. Département de Santé Publique, INSERM, Institut Pierre Louis d’Epidémiologie Et de Santé Publique, AP-HP, APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France

   Lisa Belin

5. Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France

   Jean-Pierre Frat

6. Centre d’Investigation Clinique 1402, ALIVE, Université de Poitiers, Poitiers, France

   Jean-Pierre Frat

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Contributions

AB, AD and LB analyzed the data. AD wrote the manuscript. All authors contributed to draft the manuscript or revised it critically for important intellectual content, and approved the final version of the manuscript.

Corresponding author

Correspondence to Alexandre Demoule.

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Competing interests

A Demoule reports grants from French Ministry of Health, Assistance publique—Hôpitaux de Paris, Lungpacer, Respinor, consulting fees from Respinor, Lungpace, 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. 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.

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Demoule, A., Baptiste, A., Decavèle, M. et al. Response to “Relationships between dyspnea, oxygenation and prognosis in hypoxemic respiratory failure”. Crit Care 29, 90 (2025). https://doi.org/10.1186/s13054-025-05280-3

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• Received: 09 January 2025

• Accepted: 15 January 2025

• Published: 26 February 2025

• DOI: https://doi.org/10.1186/s13054-025-05280-3

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