Intensive Care Medicine

, Volume 44, Issue 12, pp 2235–2238 | Cite as

Understanding spontaneous vs. ventilator breaths: impact and monitoring

  • Takeshi Yoshida
  • Marcelo B. P. Amato
  • Brian P. Kavanagh
Understanding the Disease


Spontaneous breathing during mechanical ventilation balances important advantages including improved oxygenation [1] and less diaphragm disuse [2] against serious disadvantages including increased injury to the lung and diaphragm [2, 3, 4, 5] and potentially lower survival [6]. 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.

Supplementary material

134_2018_5145_MOESM1_ESM.pptx (50 kb)
Supplementary material 1 (PPTX 49 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Takeshi Yoshida
    • 1
    • 2
    • 3
  • Marcelo B. P. Amato
    • 4
  • Brian P. Kavanagh
    • 2
    • 3
  1. 1.Keenan Research Centre, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  2. 2.Translational Medicine, Departments of Critical Care Medicine and Anesthesia, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  3. 3.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  4. 4.Laboratório de Pneumologia LIM-09, Disciplina de PneumologiaInstituto do Coração (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil

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