Monitoring and modulating respiratory drive in mechanically ventilated patients.

IF 3.5 3区医学 Q1 CRITICAL CARE MEDICINE

Current Opinion in Critical Care Pub Date : 2024-10-22 DOI:10.1097/MCC.0000000000001223

Sebastián Consalvo, Matías Accoce, Irene Telias

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引用次数: 0

Abstract

Purpose of review: Respiratory drive is frequently deranged in the ICU, being associated with adverse clinical outcomes. Monitoring and modulating respiratory drive to prevent potentially injurious consequences merits attention. This review gives a general overview of the available monitoring tools and interventions to modulate drive.

Recent findings: Airway occlusion pressure (P0.1) is an excellent measure of drive and is displayed on ventilators. Respiratory drive can also be estimated based on the electrical activity of respiratory muscles and measures of respiratory effort; however, high respiratory drive might be present in the context of low effort with neuromuscular weakness. Modulating a deranged drive requires a multifaceted intervention, prioritizing treatment of the underlying cause and adjusting ventilator settings for comfort. Additional tools include changes in PEEP, peak inspiratory flow, fraction of inspired oxygen, and sweep gas flow (in patients receiving extracorporeal life-support). Sedatives and opioids have differential effects on drive according to drug category. Monitoring response to any intervention is warranted and modulating drive should not preclude readiness to wean assessment or delay ventilation liberation.

Summary: Monitoring and modulating respiratory drive are feasible based on physiological principles presented in this review. However, evidence arising from clinical trials will help determine precise thresholds and optimal interventions.

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监测和调节机械通气患者的呼吸驱动力。

审查目的：重症监护室中的呼吸驱动力经常失常，与不良临床结果有关。监测和调节呼吸驱动力以防止潜在的伤害性后果值得关注。本综述概述了现有的监测工具和调节呼吸驱动力的干预措施：气道闭塞压（P0.1）是衡量呼吸驱动力的极佳指标，可在呼吸机上显示。呼吸驱动力也可以根据呼吸肌的电活动和呼吸努力程度来估算；但是，在神经肌肉无力的低努力情况下，也可能存在高呼吸驱动力。调节失常的驱动力需要多方面的干预措施，优先治疗潜在的病因，并调整呼吸机设置以达到舒适。其他工具包括改变 PEEP、吸气峰值流量、吸入氧分压和扫气流量（在接受体外生命支持的患者中）。根据药物类别的不同，镇静剂和阿片类药物对驱动力的影响也不同。监测对任何干预措施的反应都是有必要的，调节驱动力不应排除断奶准备评估或延迟通气解放。然而，临床试验中获得的证据将有助于确定精确的阈值和最佳干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Critical Care 医学-危重病医学

CiteScore

5.90

自引率

3.00%

发文量

172

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.