Airway occlusions to measure inspiratory effort, respiratory drive, and lung mechanics during noninvasive ventilation
Abstract
Rationale: In intubated patients, occlusion maneuvers allow noninvasive assessment of inspiratory effort, respiratory drive, and lung mechanics.
Objectives: To assess the feasibility of occlusion maneuvers during noninvasive ventilation (NIV).
Methods: In this multicenter study, 60 hypoxemic patients underwent 2 randomized 1-hour NIV sessions with oronasal and full-face masks after extubation. End-expiratory and end-inspiratory occlusions measured expiratory occlusion pressure (Pocc), 100-ms airway pressure drop (P0.1), and plateau pressure. Esophageal manometry, calibrated before extubation, provided reference values for inspiratory effort, assessed as esophageal pressure swing (ΔPes) and dynamic transpulmonary driving pressure (ΔPL,dyn = pressure support − ΔPes). Interface-specific conversion factors (K) translating Pocc into predicted ΔPes (K × Pocc) and predicted ΔPL,dyn (pressure support − predicted ΔPes) were derived through 100-interaction cross-validation (20-patient derivation set, 40-patient validation set).
Measurements and Main Results: Pocc was measurable in all patients. Mean K was 0.71 with the oronasal mask and 0.80 with the full-face mask. Predicted ΔPes agreed with observed ΔPes (oronasal: bias −0.41 cm H2O, 95% limits of agreement −2.3 to 1.5; full-face: 0.09, −2.9 to 3.1), and predicted ΔPL,dyn agreed with observed ΔPL,dyn (oronasal bias: 0.03, −2.9 to 2.9; full-face: −0.04, −4.3 to 4.2). Predicted ΔPes identified observed ΔPes ≤ −10 cm H2O, with areas under the receiver operating characteristic curve of 0.98 (oronasal) and 0.97 (full-face). Ventilator-derived P0.1 did not precisely quantify respiratory drive, but values >2.7 cm H2O with the oronasal mask and >3 cm H2O with the full-face mask identified high drive with specificity >90%. Plateau pressure was unstable in 78% (oronasal) and 90% (full-face) of patients. More negative predicted ΔPes, higher predicted ΔPL,dyn, and lower predicted lung compliance (expiratory tidal volume/predicted ΔPL,dyn) were associated with subsequent reintubation.
Conclusions: During NIV, Pocc-derived parameters provide noninvasive estimates of inspiratory effort, lung stress, and mechanics, whereas ventilator P0.1 and plateau pressure are less reliable.
Related
- Noninvasive ventilation in patients with amyotrophic lateral sclerosis: Is home sleep apnea testing a useful tool for initiating noninvasive ventilation?
- Risk factor analysis and development of a risk prediction model for facial pressure injury associated with noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease based on symptom science theory
- Post-Exercise Increase in Maximal Voluntary Ventilation in Swimmers and Water Polo Players: Different Changes in Spirometric Indices and Inspiratory Flow–Volume Loop Parameters
- Discomfort of noninvasive ventilation, high flow nasal cannula oxygen, and conventional oxygen implemented after extubation in non-COPD patients
- Effects of inspiratory or respiratory muscle training on respiratory function, perceived exertion, and exercise or functional performance in team-sport athletes: a systematic review and meta-analysis.
BibTeX
@article{murgolo2026airway,
title = {{Airway occlusions to measure inspiratory effort, respiratory drive, and lung mechanics during noninvasive ventilation}},
author = {Francesco Murgolo and Domenico Luca Grieco and Rossana Soloperto and Michele Bertoni and Savino Spadaro and Nicola Bartolomeo and Tommaso Pettenuzzo and François Beloncle and Delphine Venkatapen and Alessandro Cardu and Tommaso Rosà and Chiara Iacovelli and Paolo Navalesi and Salvatore M Maggiore and Ewan C Goligher and V Marco Ranieri and Lorenzo del Sorbo and Massimo Antonelli and Salvatore Grasso},
journal = {American Journal of Respiratory and Critical Care Medicine},
year = {2026},
month = jun,
doi = {10.1093/ajrccm/aamag293},
url = {https://doi.org/10.1093/ajrccm/aamag293},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Airway occlusions to measure inspiratory effort, respiratory drive, and lung mechanics during noninvasive ventilation
AU - Francesco Murgolo
AU - Domenico Luca Grieco
AU - Rossana Soloperto
AU - Michele Bertoni
AU - Savino Spadaro
AU - Nicola Bartolomeo
AU - Tommaso Pettenuzzo
AU - François Beloncle
AU - Delphine Venkatapen
AU - Alessandro Cardu
AU - Tommaso Rosà
AU - Chiara Iacovelli
AU - Paolo Navalesi
AU - Salvatore M Maggiore
AU - Ewan C Goligher
AU - V Marco Ranieri
AU - Lorenzo del Sorbo
AU - Massimo Antonelli
AU - Salvatore Grasso
PY - 2026
DA - 2026/06/13
JO - American Journal of Respiratory and Critical Care Medicine
DO - 10.1093/ajrccm/aamag293
UR - https://doi.org/10.1093/ajrccm/aamag293
AB - Rationale: In intubated patients, occlusion maneuvers allow noninvasive assessment of inspiratory effort, respiratory drive, and lung mechanics. Objectives: To assess the feasibility of occlusion maneuvers during noninvasive ventilation (NIV). Methods: In this multicenter study, 60 hypoxemic patients underwent 2 randomized 1-hour NIV sessions with oronasal and full-face masks after extubation. End-expiratory and end-inspiratory occlusions measured expiratory occlusion pressure (Pocc), 100-ms airway pressure drop (P0.1), and plateau pressure. Esophageal manometry, calibrated before extubation, provided reference values for inspiratory effort, assessed as esophageal pressure swing (ΔPes) and dynamic transpulmonary driving pressure (ΔPL,dyn = pressure support − ΔPes). Interface-specific conversion factors (K) translating Pocc into predicted ΔPes (K × Pocc) and predicted ΔPL,dyn (pressure support − predicted ΔPes) were derived through 100-interaction cross-validation (20-patient derivation set, 40-patient validation set). Measurements and Main Results: Pocc was measurable in all patients. Mean K was 0.71 with the oronasal mask and 0.80 with the full-face mask. Predicted ΔPes agreed with observed ΔPes (oronasal: bias −0.41 cm H2O, 95% limits of agreement −2.3 to 1.5; full-face: 0.09, −2.9 to 3.1), and predicted ΔPL,dyn agreed with observed ΔPL,dyn (oronasal bias: 0.03, −2.9 to 2.9; full-face: −0.04, −4.3 to 4.2). Predicted ΔPes identified observed ΔPes ≤ −10 cm H2O, with areas under the receiver operating characteristic curve of 0.98 (oronasal) and 0.97 (full-face). Ventilator-derived P0.1 did not precisely quantify respiratory drive, but values >2.7 cm H2O with the oronasal mask and >3 cm H2O with the full-face mask identified high drive with specificity >90%. Plateau pressure was unstable in 78% (oronasal) and 90% (full-face) of patients. More negative predicted ΔPes, higher predicted ΔPL,dyn, and lower predicted lung compliance (expiratory tidal volume/predicted ΔPL,dyn) were associated with subsequent reintubation. Conclusions: During NIV, Pocc-derived parameters provide noninvasive estimates of inspiratory effort, lung stress, and mechanics, whereas ventilator P0.1 and plateau pressure are less reliable.
SN - 1073-449X
SN - 1535-4970
ER -