Understanding spontaneous vs. ventilator breaths: impact and monitoring

Excerpt

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 [2‐5] 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. …