Monitoring and modulation of respiratory drive in patients with acute hypoxemic respiratory failure in spontaneous breathing.
Anna MocellinFederico GuidottiSimone RizzatoMatteo TacconiGiulia BruzziJacopo MessinaDaniele PuggioniAthina PatsouraRiccardo FantiniLuca TabbìIvana CastaniereAlessandro MarchioniEnrico CliniRoberto TonelliPublished in: Internal and emergency medicine (2024)
Non-invasive respiratory support, namely, non-invasive ventilation, continuous positive airway pressure, and high-flow nasal cannula, has been increasingly used worldwide to treat acute hypoxemic respiratory failure, giving the benefits of keeping spontaneous breathing preserved. In this scenario, monitoring and controlling respiratory drive could be helpful to avoid patient self-inflicted lung injury and promptly identify those patients that require an upgrade to invasive mechanical ventilation. In this review, we first describe the physiological components affecting respiratory drive to outline the risks associated with its hyperactivation. Further, we analyze and compare the leading strategies implemented for respiratory drive monitoring and discuss the sedative drugs and the non-pharmacological approaches used to modulate respiratory drive during non-invasive respiratory support. Refining the available techniques and rethinking our therapeutic and monitoring targets can help critical care physicians develop a personalized and minimally invasive approach.
Keyphrases
- respiratory failure
- mechanical ventilation
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- intensive care unit
- minimally invasive
- respiratory tract
- obstructive sleep apnea
- positive airway pressure
- ejection fraction
- end stage renal disease
- climate change
- prognostic factors
- peritoneal dialysis
- human health