• Anna Mocellin, Federico Guidotti, Simone Rizzato, Matteo Tacconi, Giulia Bruzzi, Jacopo Messina, Daniele Puggioni, Athina Patsoura, Riccardo Fantini, Luca Tabbì, Ivana Castaniere, Alessandro Marchioni, Enrico Clini, and Roberto Tonelli.
• Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
• Intern Emerg Med. 2024 Aug 29.

AbstractNon-invasive respiratory support, namely, non-invasive ventilation, continuous positive airway pressure, and high-flow nasal cannula, has been increasingly used worldwide to treat acute hypoxemic respiratory failure, giving the benefits of keeping spontaneous breathing preserved. In this scenario, monitoring and controlling respiratory drive could be helpful to avoid patient self-inflicted lung injury and promptly identify those patients that require an upgrade to invasive mechanical ventilation. In this review, we first describe the physiological components affecting respiratory drive to outline the risks associated with its hyperactivation. Further, we analyze and compare the leading strategies implemented for respiratory drive monitoring and discuss the sedative drugs and the non-pharmacological approaches used to modulate respiratory drive during non-invasive respiratory support. Refining the available techniques and rethinking our therapeutic and monitoring targets can help critical care physicians develop a personalized and minimally invasive approach.© 2024. The Author(s).

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