Journal of Translational Critical Care Medicine

REVIEW ARTICLE
Year
: 2021  |  Volume : 3  |  Issue : 1  |  Page : 13-

Monitoring Respiratory Drive and Effort during Mechanical Ventilation


Irene Telias1, Megan Abbott3, Laurent Brochard2 
1 Interdepartmental Division of Critical Care Medicine, University of Toronto; Department of Medicine, Division of Respirology, University Health Network and Sinai Health System; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
2 Interdepartmental Division of Critical Care Medicine, University of Toronto; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada

Correspondence Address:
Dr. Irene Telias
30 Bond Street, 4th Floor – Donnelly Wing Room 4-079, Toronto, Ontario M5B 1W8
Canada

During assisted mechanical ventilation, the respiratory system is exposed to the positive pressure from the ventilator and the negative pressure generated by the respiratory muscles. Both excessively high and low respiratory drive and effort can injure the respiratory muscles and lungs resulting in worse patient's outcomes. Monitoring respiratory drive and inspiratory effort are key to prevent harm by adjusting sedation and ventilation to meet safe targets of respiratory drive and inspiratory effort. Based on physiological studies and observational data, it is currently recommended to target an intermediate range of drive and effort in most patients, however, these targets need to be validated prospective and adjusted for different patient populations. The gold standard for measuring inspiratory effort requires the insertion of an esophageal catheter and additional equipment. However, recently, several noninvasive techniques using end-expiratory or end-inspiratory occlusions on the ventilator have been validated to estimate respiratory drive and effort allowing clinicians to monitor drive and effort easily at the bedside. In this narrative review, we discuss potential beneficial and deleterious consequences of breathing effort during assisted ventilation, available monitoring techniques, and propose a structured approach for bedside implementation.


How to cite this article:
Telias I, Abbott M, Brochard L. Monitoring Respiratory Drive and Effort during Mechanical Ventilation.J Transl Crit Care Med 2021;3:13-13


How to cite this URL:
Telias I, Abbott M, Brochard L. Monitoring Respiratory Drive and Effort during Mechanical Ventilation. J Transl Crit Care Med [serial online] 2021 [cited 2021 Nov 28 ];3:13-13
Available from: http://www.tccmjournal.com/article.asp?issn=2665-9190;year=2021;volume=3;issue=1;spage=13;epage=13;aulast=Telias;type=0