An importance of respiratory drive and effort during mechanical ventilation

Respiratory drive and effort in respiratory failure

Authors

  • Pongdhep Theerawit Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 10400
  • Phruet Soipetkasem Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 10400

DOI:

https://doi.org/10.54205/ccc.v31.259350

Keywords:

Respiratory drive, Respiratory effort, Asynchrony, P-SILI, ARDS

Abstract

During mechanical ventilation, minimizing respiratory drive and effort becomes routine to prevent patient-ventilator asynchrony (PVA). As we know, PAV associates with poor outcomes in ICU patients. As a result, prescribing sedative drugs in combination with neuro-muscular blocking agents commonly appears in many ICUs. However, many patients develop adverse events from unloading respiratory muscles, resulting in prolonged mechanical ventilator and bad clinical outcomes. This review describes both sides of the adverse effect of respiratory drive and effort and tries to suggest the optimum point, believing that it may be associated with better outcomes.

References

Zhou Y, Holets SR, Li M, Cortes-Puentes GA, Meyer TJ, Hanson AC, et al. Etiology, incidence, and outcomes of patient-ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation. Sci Rep 2021;11:12390.

Del Negro CA, Funk GD, Feldman JL. Breathing matters. Nat Rev Neurosci 2018;19:351-67.

Ikeda K, Kawakami K, Onimaru H, Okada Y, Yokota S, Koshiya N, et al. The respiratory control mechanisms in the brainstem and spinal cord: integrative views of the neuroanatomy and neurophysiology. J Physiol Sci 2017;67:45-62.

Nielsen M, Smith H. Studies on the regulation of respiration in acute hypoxia; preliminary report. Acta Physiol Scand 1951;22:44-6.

Vaporidi K, Akoumianaki E, Telias I, Goligher EC, Brochard L, Georgopoulos D. Respiratory drive in critically ill patients. pathophysiology and clinical implications. Am J Respir Crit Care Med 2020;201:20-32.

Telias I, Brochard L, Goligher EC. Is my patient's respiratory drive (too) high? Intensive Care Med 2018;44:1936-9.

Dres M, Goligher EC, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med 2017;43:1441-52.

Orozco-Levi M, Lloreta J, Minguella J, Serrano S, Broquetas JM, Gea J. Injury of the human diaphragm associated with exertion and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164:1734-9.

Jiang TX, Reid WD, Belcastro A, Road JD. Load dependence of secondary diaphragm inflammation and injury after acute inspiratory loading. Am J Respir Crit Care Med 1998;157:230-6.

Lin MC, Ebihara S, El Dwairi Q, Hussain SN, Yang L, Gottfried SB, et al. Diaphragm sarcolemmal injury is induced by sepsis and alleviated by nitric oxide synthase inhibition. Am J Respir Crit Care Med 1998;158:1656-63.

Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol 2001;537:333-45.

de Haro C, Ochagavia A, López-Aguilar J, Fernandez-Gonzalo S, Navarra-Ventura G, Magrans R, et al. Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities. Intensive Care Med Exp 2019;7:43.

Liao KM, Ou CY, Chen CW. Classifying different types of double triggering based on airway pressure and flow deflection in mechanically ventilated patients. Respir Care 2011;56:460-6.

Scott A, Wang X, Road JD, Reid WD. Increased injury and intramuscular collagen of the diaphragm in COPD: autopsy observations. Eur Respir J 2006;27:51-9.

Ahmed S, Daniel Martin A, Smith BK. Inspiratory muscle training in patients with prolonged mechanical ventilation: narrative review. Cardiopulm Phys Ther J 2019;30:44-50.

Béduneau G, Pham T, Schortgen F, Piquilloud L, Zogheib E, Jonas M, et al. Epidemiology of weaning outcome according to anew definition. The WIND Study. Am J Respir Crit Care Med 2017;195:772-83.

Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med 2018;197:204-13.

Loeb L. The mechanism in the development of pulmonary edema. Proceedings of the Society for Experimental Biology and Medicine 1928;25:321-3.

Moore RL, Binger CA. The response to respiratory resistance : a comparison of the effects produced by partial obstruction in the inspiratory and expiratory phases of respiration. J Exp Med 1927;45:1065-80.

Barach AL, Eckman M. The effects of inhalation of helium mixed with oxygen on the mechanics of respiration. J Clin Invest 1936;15:47-61.

Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988;137:1159-64.

Mascheroni D, Kolobow T, Fumagalli R, Moretti MP, Chen V, Buckhold D. Acute respiratory failure following pharmacologically induced hyperventilation: an experimental animal study. Intensive Care Med 1988;15:8-14.

Yoshida T, Uchiyama A, Matsuura N, Mashimo T, Fujino Y. The comparison of spontaneous breathing and muscle paralysis in two different severities of experimental lung injury. Crit Care Med 2013;41:536-45.

Morais CCA, Koyama Y, Yoshida T, Plens GM, Gomes S, Lima CAS, et al. High positive end-expiratory pressure renders spontaneous effort noninjurious. Am J Respir Crit Care Med 2018;197:1285-96.

Kallet RH, Alonso JA, Luce JM, Matthay MA. Exacerbation of acute pulmonary edema during assisted mechanical ventilation using a low-tidal volume, lung-protective ventilator strategy. Chest 1999;116:1826-32.

Yoshida T, Torsani V, Gomes S, De Santis RR, Beraldo MA, Costa EL, et al. Spontaneous effort causes occult pendelluft during mechanical ventilation. Am J Respir Crit Care Med 2013;188:1420-7.

Blanch L, Villagra A, Sales B, Montanya J, Lucangelo U, Luján M, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med 2015;41:633-41.

Beitler JR, Sands SA, Loring SH, Owens RL, Malhotra A, Spragg RG, et al. Quantifying unintended exposure to high tidal volumes from breath stacking dyssynchrony in ARDS: the BREATHE criteria. Intensive Care Med 2016;42:1427-36.

Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 2006;32:1515-22.

Holanda MA, Vasconcelos RDS, Ferreira JC, Pinheiro BV. Patient-ventilator asynchrony. J Bras Pneumol 2018;44:321-33.

Akoumianaki E, Lyazidi A, Rey N, Matamis D, Perez-Martinez N, Giraud R, et al. Mechanical ventilation-induced reverse-triggered breaths: a frequently unrecognized form of neuromechanical coupling. Chest 2013;143:927-38.

Baedorf Kassis E, Su HK, Graham AR, Novack V, Loring SH, Talmor DS. Reverse trigger phenotypes in acute respiratory distress syndrome. Am J Respir Crit Care Med 2021;203:67-77.

Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med 2014;189:520-31.

Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med 2008;178:346-55.

Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, et al. Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 2016;42:1360-73.

Carteaux G, Mancebo J, Mercat A, Dellamonica J, Richard JC, Aguirre-Bermeo H, et al. Bedside adjustment of proportional assist ventilation to target a predefined range of respiratory effort. Crit Care Med 2013;41:2125-32.

Bertoni M, Spadaro S, Goligher EC. Monitoring patient respiratory effort during mechanical ventilation: lung and diaphragm-protective ventilation. Crit Care 2020;24:106.

Goligher EC, Dres M, Patel BK, Sahetya SK, Beitler JR, Telias I, et al. Lung- and diaphragm-protective ventilation. Am J Respir Crit Care Med 2020;202:950-61.

Spinelli E, Mauri T, Beitler JR, Pesenti A, Brodie D. Respiratory drive in the acute respiratory distress syndrome: pathophysiology, monitoring, and therapeutic interventions. Intensive Care Med 2020;46:606-18.

Rittayamai N, Beloncle F, Goligher EC, Chen L, Mancebo J, Richard JM, et al. Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort. Ann Intensive Care 2017;7:100.

Telias I, Junhasavasdikul D, Rittayamai N, Piquilloud L, Chen L, Ferguson ND, et al. Airway occlusion pressure as an estimate of respiratory drive and inspiratory effort during assisted ventilation. Am J Respir Crit Care Med 2020;201:1086-98.

Bertoni M, Telias I, Urner M, Long M, Del Sorbo L, Fan E, et al. A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation. Crit Care 2019;23:346.

Dianti J, Bertoni M, Goligher EC. Monitoring patient-ventilator interaction by an end-expiratory occlusion maneuver. Intensive Care Med 2020;46:2338-41.

Tuinman PR, Jonkman AH, Dres M, Shi ZH, Goligher EC, Goffi A, et al. Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients-a narrative review. Intensive Care Med 2020;46:594-605.

Sinderby C, Beck J, Spahija J, Weinberg J, Grassino A. Voluntary activation of the human diaphragm in health and disease. J Appl Physiol (1985) 1998;85:2146-58.

Beck J, Gottfried SB, Navalesi P, Skrobik Y, Comtois N, Rossini M, et al. Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure. Am J Respir Crit Care Med 2001;164:419-24.

Beck J, Sinderby C, Lindström L, Grassino A. Effects of lung volume on diaphragm EMG signal strength during voluntary contractions. J Appl Physiol (1985) 1998;85:1123-34.

Carteaux G, Córdoba-Izquierdo A, Lyazidi A, Heunks L, Thille AW, Brochard L. Comparison between neurally adjusted ventilatory assist and pressure support ventilation levels in terms of respiratory effort. Crit Care Med 2016;44:503-11.

Piquilloud L, Tassaux D, Bialais E, Lambermont B, Sottiaux T, Roeseler J, et al. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction during non-invasive ventilation delivered by face mask. Intensive Care Med 2012;38:1624-31.

Bellani G, Mauri T, Coppadoro A, Grasselli G, Patroniti N, Spadaro S, et al. Estimation of patient's inspiratory effort from the electrical activity of the diaphragm. Crit Care Med 2013;41:1483-91.

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-44.

Taran Z, Namadian M, Faghihzadeh S, Naghibi T. The effect of sedation protocol using richmond agitation-sedation scale (RASS) on some clinical outcomes of mechanically ventilated patients in intensive care units: a randomized clinical trial. J Caring Sci 2019;8:199-206.

Karamchandani K, Rewari V, Trikha A, Batra RK. Bispectral index correlates well with Richmond agitation sedation scale in mechanically ventilated critically ill patients. J Anesth 2010;24:394-8.

Dzierba AL, Khalil AM, Derry KL, Madahar P, Beitler JR. Discordance between respiratory drive and sedation depth in critically ill patients receiving mechanical ventilation. Crit Care Med 2021;49:2090-101.

Downloads

Published

2023-01-13

How to Cite

1.
Theerawit P, Soipetkasem P. An importance of respiratory drive and effort during mechanical ventilation: Respiratory drive and effort in respiratory failure . Clin Crit Care [Internet]. 2023 Jan. 13 [cited 2024 Dec. 21];31(1):2023:e0001. Available from: https://he02.tci-thaijo.org/index.php/ccc/article/view/259350

Issue

Section

Review Articles