Irene Telias1,2,3, Savino Spadaro4. 1. Interdepartmental Division of Critical Care Medicine, University of Toronto. 2. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital. 3. Department of Medicine, Division of Respirology, University Health Network and Sinai Health System, Toronto, Ontario, Canada. 4. Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit University of Ferrara, Sant'Anna Hospital, Ferrara, Italy.
Abstract
PURPOSE OF REVIEW: There is increased awareness that derangements of respiratory drive and inspiratory effort are frequent and can result in lung and diaphragm injury together with dyspnea and sleep disturbances. This review aims to describe available techniques to monitor drive and effort. RECENT FINDINGS: Measuring drive and effort is necessary to quantify risk and implement strategies to minimize lung and the diaphragm injury by modifying sedation and ventilation. Evidence on the efficacy of such strategies is yet to be elucidated, but physiological and epidemiological data support the need to avoid injurious patterns of breathing effort.Some techniques have been used in research for decades (e.g., esophageal pressure or airway occlusion pressure), evidence on their practical utility is growing, and technical advances have eased implementation. More novel techniques (e.g., electrical activity of the diaphragm and ultrasound) are being investigated providing new insights on their use and interpretation. SUMMARY: Available techniques provide reliable measures of the intensity and timing of drive and effort. Simple, noninvasive techniques might be implemented in most patients and the more invasive or time-consuming in more complex patients at higher risk. We encourage clinicians to become familiar with technical details and physiological rationale of each for optimal implementation.
PURPOSE OF REVIEW: There is increased awareness that derangements of respiratory drive and inspiratory effort are frequent and can result in lung and diaphragm injury together with dyspnea and sleep disturbances. This review aims to describe available techniques to monitor drive and effort. RECENT FINDINGS: Measuring drive and effort is necessary to quantify risk and implement strategies to minimize lung and the diaphragm injury by modifying sedation and ventilation. Evidence on the efficacy of such strategies is yet to be elucidated, but physiological and epidemiological data support the need to avoid injurious patterns of breathing effort.Some techniques have been used in research for decades (e.g., esophageal pressure or airway occlusion pressure), evidence on their practical utility is growing, and technical advances have eased implementation. More novel techniques (e.g., electrical activity of the diaphragm and ultrasound) are being investigated providing new insights on their use and interpretation. SUMMARY: Available techniques provide reliable measures of the intensity and timing of drive and effort. Simple, noninvasive techniques might be implemented in most patients and the more invasive or time-consuming in more complex patients at higher risk. We encourage clinicians to become familiar with technical details and physiological rationale of each for optimal implementation.
Authors: Filippo Albani; Federica Fusina; Gianni Ciabatti; Luigi Pisani; Valeria Lippolis; Maria Elena Franceschetti; Alessia Giovannini; Rossella di Mussi; Francesco Murgolo; Antonio Rosano; Salvatore Grasso; Giuseppe Natalini Journal: Crit Care Date: 2021-12-15 Impact factor: 9.097
Authors: Annemijn H Jonkman; Michela Rauseo; Guillaume Carteaux; Irene Telias; Michael C Sklar; Leo Heunks; Laurent J Brochard Journal: Intensive Care Med Date: 2020-08-11 Impact factor: 17.440