Interdepartmental Division of Critical Care Medicine, University of Toronto.
Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital.
Curr Opin Crit Care. 2020 Feb;26(1):3-10. doi: 10.1097/MCC.0000000000000680.
There is increased awareness that derangements of respiratory drive and inspiratory effort are frequent and can result in lung and diaphragm injury together with dyspnea and sleep disturbances. This review aims to describe available techniques to monitor drive and effort.
Measuring drive and effort is necessary to quantify risk and implement strategies to minimize lung and the diaphragm injury by modifying sedation and ventilation. Evidence on the efficacy of such strategies is yet to be elucidated, but physiological and epidemiological data support the need to avoid injurious patterns of breathing effort.Some techniques have been used in research for decades (e.g., esophageal pressure or airway occlusion pressure), evidence on their practical utility is growing, and technical advances have eased implementation. More novel techniques (e.g., electrical activity of the diaphragm and ultrasound) are being investigated providing new insights on their use and interpretation.
Available techniques provide reliable measures of the intensity and timing of drive and effort. Simple, noninvasive techniques might be implemented in most patients and the more invasive or time-consuming in more complex patients at higher risk. We encourage clinicians to become familiar with technical details and physiological rationale of each for optimal implementation.
人们越来越意识到呼吸驱动和吸气努力的紊乱是很常见的，可能导致肺和膈肌损伤，同时伴有呼吸困难和睡眠障碍。本文旨在描述用于监测驱动和努力的可用技术。
测量驱动和努力对于量化风险以及通过调整镇静和通气来最小化肺和膈肌损伤非常必要。关于这些策略的疗效的证据尚待阐明，但生理和流行病学数据支持需要避免造成伤害的呼吸努力模式。一些技术已在研究中使用了数十年（例如食管压力或气道阻断压），关于其实际应用的证据正在增加，技术进步也使实施变得更加容易。更新型的技术（例如膈肌电活动和超声）正在被研究中，为其使用和解释提供了新的见解。
现有的技术提供了可靠的驱动和努力强度和时间的测量手段。简单、非侵入性的技术可能适用于大多数患者，而更具侵入性或耗时的技术可能适用于风险更高的更复杂的患者。我们鼓励临床医生熟悉每个技术的技术细节和生理原理，以实现最佳实施。
