Monitoring Respiratory Effort and Lung-distending Pressure Noninvasively during Mechanical Ventilation: Ready for Prime Time

Monitoring and managing spontaneous breathing during mechanical ventilation is a routine clinical challenge for clinicians caring for patients with acute respiratory failure. When the respiratory muscles contract in synchrony with the ventilator, the pressure applied to the lung by the respiratory muscles adds to the pressure applied by the ventilator, increasing the total pressure applied across the lung. Respiratory effort is often excessive in patients with acute respiratory failure,¹  and the resulting high lung-distending pressures may further worsen lung injury (a phenomenon referred to as patient self-inflicted lung injury).²  Vigorous respiratory efforts can also cause diaphragm myotrauma. On the other hand, when respiratory effort is insufficient, patients are at high risk for diaphragm disuse atrophy. Given increasing evidence of the physiologic and clinical relevance of these problems, respiratory effort merits close attention in mechanically ventilated patients.³  Traditionally, monitoring respiratory effort and lung-distending pressure during spontaneous breathing requires...