title: An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis.
abstract: In 2009, the American Thoracic Society (ATS) funded an assembly project, Palliative Management of Dyspnea Crisis, to focus on identification, management, and optimal resource utilization for effective palliation of acute episodes of dyspnea. We conducted a comprehensive search of the medical literature and evaluated available evidence from systematic evidence-based reviews (SEBRs) using a modified AMSTAR approach and then summarized the palliative management knowledge base for participants to use in discourse at a 2009 ATS workshop. We used an informal consensus process to develop a working definition of this novel entity and established an Ad Hoc Committee on Palliative Management of Dyspnea Crisis to further develop an official ATS document on the topic. The Ad Hoc Committee members defined dyspnea crisis as "sustained and severe resting breathing discomfort that occurs in patients with advanced, often life-limiting illness and overwhelms the patient and caregivers' ability to achieve symptom relief." Dyspnea crisis can occur suddenly and is characteristically without a reversible etiology. The workshop participants focused on dyspnea crisis management for patients in whom the goals of care are focused on palliation and for whom endotracheal intubation and mechanical ventilation are not consistent with articulated preferences. However, approaches to dyspnea crisis may also be appropriate for patients electing life-sustaining treatment. The Ad Hoc Committee developed a Workshop Report concerning assessment of dyspnea crisis; ethical and professional considerations; efficient utilization, communication, and care coordination; clinical management of dyspnea crisis; development of patient education and provider aid products; and enhancing implementation with audit and quality improvement.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mularski
authors.forename: Lynn F
authors.initials: LF
authors.lastname: Reinke
authors.forename: Virginia
authors.initials: V
authors.lastname: Carrieri-Kohlman
authors.forename: Mark D
authors.initials: MD
authors.lastname: Fischer
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Campbell
authors.forename: Graeme
authors.initials: G
authors.lastname: Rocker
authors.forename: Ann
authors.initials: A
authors.lastname: Schneidman
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jacobs
authors.forename: Robert
authors.initials: R
authors.lastname: Arnold
authors.forename: Joshua O
authors.initials: JO
authors.lastname: Benditt
authors.forename: Sara
authors.initials: S
authors.lastname: Booth
authors.forename: Ira
authors.initials: I
authors.lastname: Byock
authors.forename: Garrett K
authors.initials: GK
authors.lastname: Chan
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Doranne
authors.initials: D
authors.lastname: Donesky
authors.forename: John
authors.initials: J
authors.lastname: Hansen-Flaschen
authors.forename: John
authors.initials: J
authors.lastname: Heffner
authors.forename: Russell
authors.initials: R
authors.lastname: Klein
authors.forename: Trina M
authors.initials: TM
authors.lastname: Limberg
authors.forename: Harold L
authors.initials: HL
authors.lastname: Manning
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ries
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Schmidt
authors.forename: Paul A
authors.initials: PA
authors.lastname: Selecky
authors.forename: Robert D
authors.initials: RD
authors.lastname: Truog
authors.forename: Angela C C
authors.initials: AC
authors.lastname: Wang
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D000208:Acute Disease; D004417:Dyspnea / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D010347:Patient Care Planning