Respiratory Drive in Critically Ill Patients. Pathophysiology and Clinical Implications

Area of Science:

• Critical care medicine
• Respiratory physiology

Background:

• Mechanical ventilation can harm patients if respiratory effort is too strong or too weak.
• Critical illness impacts respiratory drive via cortical, metabolic, and chemical feedback systems.
• Chemical feedback, responding to blood gases and pH, is a key determinant of respiratory drive.

Purpose of the Study:

• To review determinants of respiratory drive in critically ill patients.
• To describe bedside assessment tools for respiratory drive.
• To discuss implications of altered respiratory drive during mechanical ventilation.

Main Methods:

• State-of-the-art review of existing literature.
• Analysis of arterial carbon dioxide levels and brain response.
• Contrast of brain response with alveolar ventilation during unassisted and assisted breathing.

Main Results:

• Critical illness affects respiratory drive through multiple pathways.
• Chemical feedback system significantly influences respiratory drive.
• Altered respiratory drive has implications for mechanical ventilation.

Conclusions:

• Assessing respiratory drive at the bedside can improve patient management.
• Optimizing mechanical ventilation requires consideration of patient's respiratory drive.
• Avoiding over- and under-assistance is key for better patient outcomes.