Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, Via F. Sforza 35, 20122, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Intensive Care Med. 2020 Apr;46(4):606-618. doi: 10.1007/s00134-020-05942-6. Epub 2020 Feb 3.
Neural respiratory drive, i.e., the activity of respiratory centres controlling breathing, is an overlooked physiologic variable which affects the pathophysiology and the clinical outcome of acute respiratory distress syndrome (ARDS). Spontaneous breathing may offer multiple physiologic benefits in these patients, including decreased need for sedation, preserved diaphragm activity and improved cardiovascular function. However, excessive effort to breathe due to high respiratory drive may lead to patient self-inflicted lung injury (P-SILI), even in the absence of mechanical ventilation. In the present review, we focus on the physiological and clinical implications of control of respiratory drive in ARDS patients. We summarize the main determinants of neural respiratory drive and the mechanisms involved in its potentiation, in health and ARDS. We also describe potential and pitfalls of the available bedside methods for drive assessment and explore classical and more "futuristic" interventions to control drive in ARDS patients.
神经呼吸驱动，即控制呼吸的呼吸中枢的活动，是一个被忽视的生理变量，它影响急性呼吸窘迫综合征（ARDS）的病理生理学和临床结果。在这些患者中，自主呼吸可能提供多种生理益处，包括减少镇静需求、保留膈肌活动和改善心血管功能。然而，由于呼吸驱动过高而导致的过度呼吸努力可能导致患者自行造成的肺损伤（P-SILI），即使在没有机械通气的情况下也是如此。在本综述中，我们重点关注 ARDS 患者呼吸驱动控制的生理和临床意义。我们总结了神经呼吸驱动的主要决定因素及其在健康和 ARDS 中增强的机制。我们还描述了可用的床边驱动评估方法的潜力和陷阱，并探讨了控制 ARDS 患者驱动的经典和更“未来主义”的干预措施。
