Recognizing and managing excessive respiratory drive and effort: an expert narrative review
Puntos clave
The goal is to assess and manage excessive respiratory drive and effort in clinical practice.
Reviewed ventilator-derived parameters and imaging modalities for assessing respiratory effort.
Discussed the role of esophageal manometry and diaphragm electromyography.
Identified advanced lung-protective interventions and sedation optimization strategies.
Highlighted the importance of balancing excessive and insufficient respiratory effort for better outcomes.
Identified emerging imaging technologies for real-time assessment of respiratory effort.
Clarified future priorities for optimizing intubation timing and monitoring techniques.
Resumen
Accurate assessment of respiratory drive and effort - using ventilator-derived parameters, esophageal manometry, diaphragm electromyography, and imaging modalities - is vital, though not yet standard in clinical practice. Management should aim to correct underlying causes of heightened drive, optimize sedation and ventilator settings, and apply advanced lung-protective interventions when appropriate. Future priorities include improving monitoring techniques, clarifying whether inspiratory effort or lung stress should be prioritized, and determining optimal timing for intubation. Balancing excessive and insufficient effort is essential, as both P-SILI and diaphragmatic disuse can worsen outcomes. Emerging imaging technologies may enhance real-time assessment of regional strain and effort. Ultimately, integrating physiological monitoring with individualized ventilatory management is fundamental to protect the lung while preserving respiratory muscle function and improving patient outcomes.
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