Modification of Respiratory Drive and Lung Stress by Level of Support Pressure and ECMO Sweep Gas Flow in Patients With Severe COVID-19–Associated Acute Respiratory Distress Syndrome: an Exploratory Retrospective Analysis

Jung, Carolin; Gillmann, Hans-Jörg; Stueber, Thomas

doi:10.1053/j.jvca.2023.09.040

Journal of Cardiothoracic and Vascular Anesthesia

2024

DOI: 10.1053/j.jvca.2023.09.040

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Modification of Respiratory Drive and Lung Stress by Level of Support Pressure and ECMO Sweep Gas Flow in Patients With Severe COVID-19–Associated Acute Respiratory Distress Syndrome: an Exploratory Retrospective Analysis

Carolin Jung,

Hans-Jörg Gillmann,

Thomas Stueber

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2024

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Cited by 3 publications

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Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient

Luján,

Cinesi Gómez,

Peñuelas

et al. 2024

Archivos de Bronconeumología

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Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient

Luján,

Cinesi Gómez,

Peñuelas

et al. 2024

Archivos de Bronconeumología

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Monitoring and modulating respiratory drive in mechanically ventilated patients

Consalvo,

Accoce,

Telias

2024

Current Opinion in Critical Care

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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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Advances in achieving lung and diaphragm-protective ventilation

van den Berg,

Heunks,

Doorduin

2024

Current Opinion in Critical Care

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Purpose of review Mechanical ventilation may have adverse effects on diaphragm and lung function. Lung- and diaphragm-protective ventilation is an approach that challenges the clinician to facilitate physiological respiratory efforts, while maintaining minimal lung stress and strain. Here, we discuss the latest advances in monitoring and interventions to achieve lung- and diaphragm protective ventilation. Recent findings Noninvasive ventilator maneuvers (P0.1, airway occlusion pressure, pressure-muscle index) can accurately detect low and excessive respiratory efforts and high lung stress. Additional monitoring techniques include esophageal manometry, ultrasound, electrical activity of the diaphragm, and electrical impedance tomography. Recent trials demonstrate that a systematic approach to titrating inspiratory support and sedation facilitates lung- and diaphragm protective ventilation. Titration of positive-end expiratory pressure and, if available, veno-venous extracorporeal membrane oxygenation sweep gas flow may further modulate neural respiratory drive and effort to facilitate lung- and diaphragm protective ventilation. Summary Achieving lung- and diaphragm-protective ventilation may require more than a single intervention; it demands a comprehensive understanding of the (neuro)physiology of breathing and mechanical ventilation, along with the application of a series of interventions under close monitoring. We suggest a bedside-approach to achieve lung- and diaphragm protective ventilation targets.

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Modification of Respiratory Drive and Lung Stress by Level of Support Pressure and ECMO Sweep Gas Flow in Patients With Severe COVID-19–Associated Acute Respiratory Distress Syndrome: an Exploratory Retrospective Analysis

Cited by 3 publications

References 38 publications

Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient

Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient

Monitoring and modulating respiratory drive in mechanically ventilated patients

Advances in achieving lung and diaphragm-protective ventilation

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