Consalvo Sebastián, Accoce Matías, Telias Irene
Intensive Care Unit, Hospital Británico, Ciudad Autónoma de Buenos Aires.
Intensive Care Unit, Sanatorio Anchorena San Martín, Provincia de Buenos Aires.
Curr Opin Crit Care. 2025 Feb 1;31(1):30-37. doi: 10.1097/MCC.0000000000001223. Epub 2024 Oct 21.
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.
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.
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.
呼吸驱动在重症监护病房（ICU）中常出现紊乱，与不良临床结局相关。监测和调节呼吸驱动以预防潜在的有害后果值得关注。本综述对现有的监测工具和调节驱动的干预措施进行了概述。
气道闭塞压（P0.1）是驱动的一项出色指标，可在呼吸机上显示。呼吸驱动也可根据呼吸肌的电活动和呼吸努力程度来估计；然而，在存在神经肌肉无力且呼吸努力程度较低的情况下，可能存在高呼吸驱动。调节紊乱的驱动需要多方面的干预，优先治疗潜在病因并调整呼吸机设置以提高舒适度。其他工具包括调整呼气末正压（PEEP）、吸气峰流速、吸入氧分数以及（接受体外生命支持的患者的）扫气流量。镇静剂和阿片类药物根据药物类别对驱动有不同影响。有必要监测对任何干预的反应，调节驱动不应排除进行撤机评估的准备或延迟通气解放。
基于本综述中阐述的生理原理，监测和调节呼吸驱动是可行的。然而，临床试验产生的证据将有助于确定精确的阈值和最佳干预措施。
