Understanding spontaneous vs. ventilator breaths: impact and monitoring
Spontaneous breathing during mechanical ventilation balances important advantages including improved oxygenation  and less diaphragm disuse  against serious disadvantages including increased injury to the lung and diaphragm [2, 3, 4, 5] and potentially lower survival . Of course, spontaneous breathing is an absolute requirement for successful weaning, and so it must ultimately be a goal in all patients. While the traditional focus in acute respiratory distress syndrome (ARDS) is on controlling and monitoring ventilator breaths, recent advances point to important differences between spontaneous and mechanical breaths in terms of pathophysiology and monitoring [3, 4, 7]. This paper reviews these insights and provides suggestions for bedside monitoring of spontaneous effort in patients with ARDS during mechanical ventilation, focusing on the use of esophageal manometry.
Monitoring mechanical breaths
During a mechanical breath (i.e., without spontaneous effort),...
Compliance with ethical standards
Conflicts of interest
TY and BPK have applied for a patent on a CNAP (continuous negative abdominal pressure) device.
- 2.Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Vorona S, Sklar MC, Rittayamai N, Lanys A, Murray A, Brace D, Urrea C, Reid WD, Tomlinson G, Slutsky AS, Kavanagh BP, Brochard LJ, Ferguson ND (2018) Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med 197:204–213CrossRefGoogle Scholar
- 3.Yoshida T, Nakahashi S, Nakamura MAM, Koyama Y, Roldan R, Torsani V, De Santis RR, Gomes S, Uchiyama A, Amato MBP, Kavanagh BP, Fujino Y (2017) Volume-controlled ventilation does not prevent injurious inflation during spontaneous effort. Am J Respir Crit Care Med 196:590–601CrossRefPubMedGoogle Scholar
- 4.Morais CCA, Koyama Y, Yoshida T, Plens GM, Gomes S, Lima C, Ramos OP, Pereira SM, Kawaguchi N, Yamamoto H, Uchiyama A, Borges JB, Vidal Melo MF, Tucci MR, Amato MBP, Kavanagh BP, Costa ELV, Fujino Y (2018) High positive end-expiratory pressure renders spontaneous effort non-injurious. Am J Resp Crit Care Med. https://doi.org/10.1164/rccm.201706-1244OC CrossRefPubMedGoogle Scholar
- 5.Magalhaes PAF, Padilha GA, Moraes L, Santos CL, Maia LA, Braga CL, Duarte M, Andrade LB, Schanaider A, Capellozzi VL, Huhle R, Gama de Abreu M, Pelosi P, Rocco PRM, Silva PL (2018) Effects of pressure support ventilation on ventilator-induced lung injury in mild acute respiratory distress syndrome depend on level of positive end-expiratory pressure: a randomised animal study. Eur J Anaesthesiol 35:298–306CrossRefGoogle Scholar
- 6.Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, Mojoli F, Chiumello D, Piquilloud L, Grasso S, Jubran A, Laghi F, Magder S, Pesenti A, Loring S, Gattinoni L, Talmor D, Blanch L, Amato M, Chen L, Brochard L, Mancebo J (2016) Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 42:1360–1373CrossRefPubMedGoogle Scholar