Bedside assessment of respiratory drive and effort: The role and limitations of non-invasive occlusion maneuvers.

Accurate assessment of respiratory drive and effort is important in critically ill patients receiving invasive or noninvasive mechanical ventilation. This review summarizes the physiology of breathing, with particular emphasis on respiratory drive, inspiratory effort, and work of breathing and on the clinical significance of their measurement. Reference techniques are discussed, but the main focus is on noninvasive airway occlusion maneuvers (P0.1, Pocc, and PMI) as bedside surrogates of respiratory drive and effort. Patient variability and technical factors may lead to misinterpretation and limit patient-level precision. Nevertheless, these measurements may help identify abnormal respiratory drive or effort and support individualized ventilatory assistance. A sound understanding of the underlying physiology is essential for valid application. This review provides a framework for interpreting occlusion maneuvers as complementary monitoring tools and discusses the challenges involved in their bedside use. SUMMARY STATEMENT: This review assesses noninvasive methods for evaluating respiratory drive and effort as alternatives to invasive techniques during mechanical ventilation.