{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:32:27Z","timestamp":1780450347258,"version":"3.54.1"},"reference-count":94,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,19]],"date-time":"2022-03-19T00:00:00Z","timestamp":1647648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The latest guidelines for the hospital care of patients affected by coronavirus disease 2019 (COVID-19)-related acute respiratory failure have moved towards the widely accepted use of noninvasive respiratory support (NIRS) as opposed to early intubation at the pandemic onset. The establishment of severe COVID-19 pneumonia goes through different pathophysiological phases that partially resemble typical acute respiratory distress syndrome (ARDS) and have been categorized into different clinical\u2013radiological phenotypes. These can variably benefit on the application of external positive end-expiratory pressure (PEEP) during noninvasive mechanical ventilation, mainly due to variable levels of lung recruitment ability and lung compliance during different phases of the disease. A growing body of evidence suggests that intense respiratory effort producing excessive negative pleural pressure swings (Ppl) plays a critical role in the onset and progression of lung and diaphragm damage in patients treated with noninvasive respiratory support. Routine respiratory monitoring is mandatory to avoid the nasty continuation of NIRS in patients who are at higher risk for respiratory deterioration and could benefit from early initiation of invasive mechanical ventilation instead. Here we propose different monitoring methods both in the clinical and experimental settings adapted for this purpose, although further research is required to allow their extensive application in clinical practice. We reviewed the needs and available tools for clinical\u2013physiological monitoring that aims at optimizing the ventilatory management of patients affected by acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.<\/jats:p>","DOI":"10.3390\/jcm11061704","type":"journal-article","created":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T21:30:14Z","timestamp":1647811814000},"page":"1704","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["Different Methods to Improve the Monitoring of Noninvasive Respiratory Support of Patients with Severe Pneumonia\/ARDS Due to COVID-19: An Update"],"prefix":"10.3390","volume":"11","author":[{"given":"Paolo","family":"Pelosi","sequence":"first","affiliation":[{"name":"Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy"},{"name":"Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6202-0758","authenticated-orcid":false,"given":"Roberto","family":"Tonelli","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy"},{"name":"Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Torregiani","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1061-9507","authenticated-orcid":false,"given":"Elisa","family":"Baratella","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4791-768X","authenticated-orcid":false,"given":"Marco","family":"Confalonieri","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-6442","authenticated-orcid":false,"given":"Denise","family":"Battaglini","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy"},{"name":"Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3720-3517","authenticated-orcid":false,"given":"Alessandro","family":"Marchioni","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7284-5016","authenticated-orcid":false,"given":"Paola","family":"Confalonieri","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1515-5094","authenticated-orcid":false,"given":"Enrico","family":"Clini","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences SMECHIMAI, University of Modena Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0864-9766","authenticated-orcid":false,"given":"Francesco","family":"Salton","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-859X","authenticated-orcid":false,"given":"Barbara","family":"Ruaro","sequence":"additional","affiliation":[{"name":"Pulmonology Department, Cattinara Hospital, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,19]]},"reference":[{"key":"ref_1","unstructured":"WHO (2022, February 16). WHO Coronavirus (COVID-19) Dashboard. Available online: https:\/\/covid19.who.int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s13613-022-00980-3","article-title":"Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019","volume":"12","author":"Hermann","year":"2022","journal-title":"Ann. Intensive Care"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ball, L., Barisione, E., Mastracci, L., Campora, M., Costa, D., Robba, C., Battaglini, D., Micali, M., Costantino, F., and Cittadini, G. (2021). Extension of Collagen Deposition in COVID-19 Post Mortem Lung Samples and Computed Tomography Analysis Findings. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22147498"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Baratella, E., Ruaro, B., Marrocchio, C., Starvaggi, N., Salton, F., Giudici, F., Quaia, E., Confalonieri, M., and Cova, M.A. (2021). Interstitial Lung Disease at High Resolution CT after SARS-CoV-2-Related Acute Respiratory Distress Syndrome According to Pulmonary Segmental Anatomy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10173985"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1164\/rccm.201610-2156SO","article-title":"Fifty Years of Research in ARDS. Gas Exchange in Acute Respiratory Distress Syndrome","volume":"196","author":"Radermacher","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1183\/09031936.00037014","article-title":"Gas exchange and ventilation\u2013perfusion relationships in the lung","volume":"44","author":"Petersson","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S2213-2600(20)30459-8","article-title":"Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): A national, multicentre, observational cohort study","volume":"9","author":"Botta","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1097\/MCC.0b013e3282f2405b","article-title":"Pulmonary and extrapulmonary acute respiratory distress syndrome: Myth or reality?","volume":"14","author":"Rocco","year":"2008","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1007\/s00134-020-06289-8","article-title":"Pharmacological principles guiding prolonged glucocorticoid treatment in ARDS","volume":"46","author":"Meduri","year":"2020","journal-title":"Intensiv. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1164\/ajrccm.164.9.2103121","article-title":"What Has Computed Tomography Taught Us about the Acute Respiratory Distress Syndrome?","volume":"164","author":"Gattinoni","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1164\/ajrccm.149.1.8111603","article-title":"Vertical gradient of regional lung inflation in adult respiratory distress syndrome","volume":"149","author":"Pelosi","year":"1994","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00134-020-06033-2","article-title":"COVID-19 pneumonia: Different respiratory treatments for different phenotypes?","volume":"46","author":"Gattinoni","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1111\/j.1440-1843.2011.02048.x","article-title":"Changes in lung composition and regional perfusion and tissue distribution in patients with ARDS","volume":"16","author":"Dakin","year":"2011","journal-title":"Respirology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Salton, F., Confalonieri, P., Meduri, G.U., Santus, P., Harari, S., Scala, R., Lanini, S., Vertui, V., Oggionni, T., and Caminati, A. (2020). Prolonged Low-Dose Methylprednisolone in Patients With Severe COVID-19 Pneumonia. Open Forum Infect. Dis., 7.","DOI":"10.1093\/ofid\/ofaa421"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ruaro, B., Salton, F., Braga, L., Wade, B., Confalonieri, P., Volpe, M.C., Baratella, E., Maiocchi, S., and Confalonieri, M. (2021). The History and Mystery of Alveolar Epithelial Type II Cells: Focus on Their Physiologic and Pathologic Role in Lung. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22052566"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Orlandi, M., Landini, N., Sambataro, G., Nardi, C., Tofani, L., Bruni, C., Randone, S.B., Blagojevic, J., Melchiorre, D., and Hughes, M. (2021). The role of chest CT in deciphering interstitial lung involvement: Systemic sclerosis versus COVID-19. Rheumatology, ahead of print.","DOI":"10.1093\/rheumatology\/keab615"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1186\/s13054-021-03610-9","article-title":"Lung distribution of gas and blood volume in critically ill COVID-19 patients: A quantitative dual-energy computed tomography study","volume":"25","author":"Ball","year":"2021","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1080\/17476348.2021.1906226","article-title":"Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19","volume":"15","author":"Robba","year":"2021","journal-title":"Expert Rev. Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1164\/ajrccm.163.6.2005001","article-title":"Computed Tomography Assessment of Positive End-expiratory Pressure-induced Alveolar Recruitment in Patients with Acute Respiratory Distress Syndrome","volume":"163","author":"Malbouisson","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s13054-021-03477-w","article-title":"Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia","volume":"25","author":"Ball","year":"2021","journal-title":"Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"103455","DOI":"10.1016\/j.resp.2020.103455","article-title":"Distinct phenotypes require distinct respiratory management strategies in severe COVID-19","volume":"279","author":"Robba","year":"2020","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_22","first-page":"PA1771","article-title":"Monitoring lung mechanics by oscillometry in COVID 19 ARDS receiving non-invasive ventilation: A pilot study","volume":"58","author":"Torregiani","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tonelli, R., Marchioni, A., Tabb\u00ec, L., Fantini, R., Busani, S., Castaniere, I., Andrisani, D., Gozzi, F., Bruzzi, G., and Manicardi, L. (2021). Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario. J. Clin. Med., 10.","DOI":"10.3390\/jcm10050975"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100829","DOI":"10.1016\/j.eclinm.2021.100829","article-title":"Identifying clinical and biochemical phenotypes in acute respiratory distress syndrome secondary to coronavirus disease-2019","volume":"34","author":"Ranjeva","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e20200226","DOI":"10.36416\/1806-3756\/e20200226","article-title":"Severity of lung involvement on chest X-rays in SARS-coronavirus-2 infected patients as a possible tool to predict clinical progression: An observational retrospective analysis of the relationship between radiological, clinical, and laboratory data","volume":"46","author":"Baratella","year":"2020","journal-title":"J. Bras. Pneumol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s11547-020-01200-3","article-title":"COVID-19 outbreak in Italy: Experimental chest X-ray scoring system for quantifying and monitoring disease progression","volume":"125","author":"Borghesi","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2004133","DOI":"10.1183\/13993003.04133-2020","article-title":"Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease","volume":"58","author":"Morris","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"E86","DOI":"10.1148\/radiol.2020201433","article-title":"Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia","volume":"296","author":"Colombi","year":"2020","journal-title":"Radiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1007\/s00330-021-08317-7","article-title":"COVID-19 pneumonia imaging follow-up: When and how? A proposition from ESTI and ESR","volume":"32","author":"Martini","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.52586\/5053","article-title":"Potential links between COVID-19-associated pulmonary aspergillosis and bronchiectasis as detected by high resolution computed tomography","volume":"26","author":"Baratella","year":"2021","journal-title":"Front. Biosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E177","DOI":"10.1148\/radiol.2021203153","article-title":"Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia","volume":"299","author":"Han","year":"2021","journal-title":"Radiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"E396","DOI":"10.1148\/radiol.2021210834","article-title":"Post-Acute Sequelae of COVID-19 Pneumonia: Six-month Chest CT Follow-up","volume":"301","author":"Caruso","year":"2021","journal-title":"Radiology"},{"key":"ref_33","first-page":"100023","article-title":"Converging pathways in pulmonary fibrosis and COVID-19\u2014The fibrotic link to disease severity","volume":"2","author":"Bjermer","year":"2020","journal-title":"Respir. Med. X"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11547-011-0740-3","article-title":"Post-ARDS pulmonary fibrosis in patients with H1N1 pneumonia: Role of follow-up CT","volume":"117","author":"Mineo","year":"2012","journal-title":"Radiol. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/S0140-6736(20)32656-8","article-title":"6-month consequences of COVID-19 in patients discharged from hospital: A cohort study","volume":"397","author":"Huang","year":"2021","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1007\/s00134-020-06186-0","article-title":"Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia","volume":"46","author":"Zieleskiewicz","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2918","DOI":"10.1016\/j.ultrasmedbio.2020.07.003","article-title":"Correlation between Chest Computed Tomography and Lung Ultrasonography in Patients with Coronavirus Disease 2019 (COVID-19)","volume":"46","year":"2020","journal-title":"Ultrasound Med. Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1002\/jum.15521","article-title":"Comparison Between Lung Ultrasound and Computed Tomographic Findings in Patients With COVID-19 Pneumonia","volume":"40","author":"Lopes","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e048795","DOI":"10.1136\/bmjopen-2021-048795","article-title":"Comparing lung ultrasound: Extensive versus short in COVID-19 (CLUES): A multicentre, observational study at the emergency department","volume":"11","author":"Kok","year":"2021","journal-title":"BMJ Open"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Gutsche, H., Lesser, T.G., Wolfram, F., and Doenst, T. (2021). Significance of Lung Ultrasound in Patients with Suspected COVID-19 Infection at Hospital Admission. Diagnostics, 11.","DOI":"10.3390\/diagnostics11060921"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ejim.2021.06.004","article-title":"Lung ultrasound in COVID-19: Insights from the frontline and research experiences","volume":"90","author":"Cogliati","year":"2021","journal-title":"Eur. J. Intern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2003448","DOI":"10.1183\/13993003.03448-2020","article-title":"Dyspnoea, lung function and CT findings 3 months after hospital admission for COVID-19","volume":"57","author":"Lerum","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2908","DOI":"10.1016\/j.ultrasmedbio.2020.07.018","article-title":"Lung Ultrasound May Support Diagnosis and Monitoring of COVID-19 Pneumonia","volume":"46","author":"Allinovi","year":"2020","journal-title":"Ultrasound Med. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.4103\/jcecho.jcecho_59_20","article-title":"The Role of Imaging in COVID-19 Pneumonia Diagnosis and Management: Main Positions of the Experts, Key Imaging Features and Open Answers","volume":"30","author":"Landini","year":"2020","journal-title":"J. Cardiovasc. Echogr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S129","DOI":"10.5152\/eurjrheum.2020.2063","article-title":"The emerging role of lung ultrasound in COVID-19 pneumonia","volume":"7","author":"Lepri","year":"2020","journal-title":"Eur. J. Rheumatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1007\/s00431-020-03706-4","article-title":"Point-of-care lung ultrasound in three neonates with COVID-19","volume":"179","year":"2020","journal-title":"Eur. J. Pediatr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.annemergmed.2020.10.008","article-title":"Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department","volume":"77","author":"Pivetta","year":"2021","journal-title":"Ann. Emerg. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1007\/s11739-020-02524-8","article-title":"The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak","volume":"16","author":"Sorlini","year":"2021","journal-title":"Intern. Emerg. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1007\/s11547-020-01236-5","article-title":"The lung ultrasound: Facts or artifacts? In the era of COVID-19 outbreak","volume":"125","author":"Notaro","year":"2020","journal-title":"Radiol. Med."},{"key":"ref_50","first-page":"766","article-title":"A single-center comparative study of lung ultrasound versus chest computed tomography during the COVID-19 era","volume":"16","author":"Rajan","year":"2021","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1016\/j.chest.2020.05.604","article-title":"Self-Performed Lung Ultrasound for Home Monitoring of a Patient Positive for Coronavirus Disease 2019","volume":"158","author":"Pivetta","year":"2020","journal-title":"Chest"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1183\/20734735.020514","article-title":"Measuring lung function using sound waves: Role of the forced oscillation technique and impulse oscillometry system","volume":"11","author":"Brashier","year":"2015","journal-title":"Breathe"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1615\/CritRevBiomedEng.v39.i4.60","article-title":"Oscillation Mechanics of the Respiratory System: Applications to Lung Disease","volume":"39","author":"Kaczka","year":"2011","journal-title":"Crit. Rev. Biomed. Eng."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1183\/09031936.00041713","article-title":"The safety and feasibility of the inhaled mannitol challenge test in young children","volume":"42","author":"Alblooshi","year":"2013","journal-title":"Eur. Respir. J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1136\/thoraxjnl-2015-207401","article-title":"Determinants of early-life lung function in African infants","volume":"72","author":"Gray","year":"2017","journal-title":"Thorax"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1034\/j.1399-3003.2000.15b16.x","article-title":"Noninvasive assessment of respiratory resistance in severe chronic respiratory patients with nasal CPAP","volume":"15","author":"Gavela","year":"2000","journal-title":"Eur. Respir. J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1183\/09031936.06.00080005","article-title":"Noninvasive detection of expiratory flow limitation in COPD patients during nasal CPAP","volume":"27","author":"Rotger","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.resp.2010.03.004","article-title":"Airway and tissue mechanics in ventilated patients with pneumonia","volume":"171","author":"Lorx","year":"2010","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1164\/rccm.201712-2404OC","article-title":"Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial","volume":"198","author":"Walker","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1007\/s00134-009-1673-3","article-title":"Lung recruitment assessed by total respiratory system input reactance","volume":"35","author":"Dellaca","year":"2009","journal-title":"Intensive Care Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1901650","DOI":"10.1183\/13993003.01650-2019","article-title":"Forced oscillation technique for optimising PEEP in ventilated extremely preterm infants","volume":"55","author":"Veneroni","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s00134-011-2211-7","article-title":"Optimisation of positive end-expiratory pressure by forced oscillation technique in a lavage model of acute lung injury","volume":"37","author":"Zannin","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s13054-021-03540-6","article-title":"Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: A systematic review and meta-analysis of non-randomized cohort studies","volume":"25","author":"Papoutsi","year":"2021","journal-title":"Crit. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"00346","DOI":"10.1183\/23120541.00346-2021","article-title":"Radiological-pathological signatures of patients with COVID-19-related pneumomediastinum: Is there a role for the Sonic hedgehog and Wnt5a pathways?","volume":"7","author":"Baratella","year":"2021","journal-title":"ERJ Open Res."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Battaglini, D., Caiffa, S., Gasti, G., Ciaravolo, E., Robba, C., Herrmann, J., Gerard, S., Bassetti, M., Pelosi, P., and Ball, L. (2021). An Experimental Pre-Post Study on the Efficacy of Respiratory Physiotherapy in Severe Critically III COVID-19 Patients. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102139"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"103529","DOI":"10.1016\/j.resp.2020.103529","article-title":"Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19","volume":"282","author":"Battaglini","year":"2020","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1164\/ajrccm.164.1.2001078","article-title":"Long-Term Effects of Spontaneous Breathing During Ventilatory Support in Patients with Acute Lung Injury","volume":"164","author":"Putensen","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1164\/rccm.201703-0536OC","article-title":"Mechanical Ventilation\u2013induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes","volume":"197","author":"Goligher","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/BF00255628","article-title":"Acute respiratory failure following pharmacologically induced hyperventilation: An experimental animal study","volume":"15","author":"Mascheroni","year":"1988","journal-title":"Intensive Care Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1164\/rccm.201912-2512OC","article-title":"Early Inspiratory Effort Assessment by Esophageal Manometry Predicts Noninvasive Ventilation Outcome in De Novo Respiratory Failure. A Pilot Study","volume":"202","author":"Tonelli","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1164\/rccm.201605-1081CP","article-title":"Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure","volume":"195","author":"Brochard","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1164\/rccm.201503-0620OC","article-title":"Evolution of Diaphragm Thickness during Mechanical Ventilation. Impact of Inspiratory Effort","volume":"192","author":"Goligher","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/0034-5687(73)90039-X","article-title":"Continuous recording of pleural surface pressure at various sites","volume":"19","author":"Agostoni","year":"1973","journal-title":"Respir. Physiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1152\/jappl.1974.37.4.505","article-title":"Ipsilateral transpulmonary pressures during unilateral electrophrenic respiration","volume":"37","author":"Minh","year":"1974","journal-title":"J. Appl. Physiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1097\/CCM.0b013e3182711972","article-title":"The Comparison of Spontaneous Breathing and Muscle Paralysis in Two Different Severities of Experimental Lung Injury*","volume":"41","author":"Yoshida","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1164\/rccm.201610-1972OC","article-title":"Volume-controlled Ventilation Does Not Prevent Injurious Inflation during Spontaneous Effort","volume":"196","author":"Yoshida","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1186\/cc2392","article-title":"Bench-to-bedside review: Microvascular and airspace linkage in ventilator-induced lung injury","volume":"7","author":"Marini","year":"2003","journal-title":"Crit. Care"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1164\/rccm.201412-2214OC","article-title":"Diaphragm Muscle Fiber Weakness and Ubiquitin\u2013Proteasome Activation in Critically Ill Patients","volume":"191","author":"Hooijman","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Giustivi, D., Bottazzini, F., and Belliato, M. (2021). Respiratory Monitoring at Bedside in COVID-19 Patients. J. Clin. Med., 10.","DOI":"10.3390\/jcm10214943"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s00134-020-05979-7","article-title":"Critical care crisis and some recommendations during the COVID-19 epidemic in China","volume":"46","author":"Xie","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/s12931-020-01462-5","article-title":"The pathophysiology of \u2018happy\u2019 hypoxemia in COVID-19","volume":"21","author":"Dhont","year":"2020","journal-title":"Respir. Res."},{"key":"ref_83","first-page":"e40","article-title":"Lack of dyspnea in patients with COVID-19: Another neurological conundrum?","volume":"27","author":"Rubio","year":"2020","journal-title":"Eur. J. Neurol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1164\/rccm.202104-1029LE","article-title":"Inspiratory Effort and Lung Mechanics in Spontaneously Breathing Patients with Acute Respiratory Failure due to COVID-19: A Matched Control Study","volume":"204","author":"Tonelli","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e437","DOI":"10.1016\/j.bja.2020.07.045","article-title":"Oesophageal manometry and gas exchange in patients with COVID-19 acute respiratory distress syndrome","volume":"125","author":"Coppola","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s40635-019-0243-4","article-title":"Power to mechanical power to minimize ventilator-induced lung injury?","volume":"7","author":"Silva","year":"2019","journal-title":"Intensive Care Med. Exp."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1007\/s00134-019-05636-8","article-title":"Calculation of mechanical power for pressure-controlled ventilation","volume":"45","author":"Becher","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1164\/rccm.202005-1582LE","article-title":"High Respiratory Drive and Excessive Respiratory Efforts Predict Relapse of Respiratory Failure in Critically Ill Patients with COVID-19","volume":"202","author":"Esnault","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s13613-021-00904-7","article-title":"High risk of patient self-inflicted lung injury in COVID-19 with frequently encountered spontaneous breathing patterns: A computational modelling study","volume":"11","author":"Weaver","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/MCC.0000000000000494","article-title":"Esophageal pressure monitoring","volume":"24","author":"Yoshida","year":"2018","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1001\/jama.2020.6825","article-title":"Management of COVID-19 Respiratory Distress","volume":"323","author":"Marini","year":"2020","journal-title":"JAMA"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1164\/rccm.201312-2193CI","article-title":"The Application of Esophageal Pressure Measurement in Patients with Respiratory Failure","volume":"189","author":"Akoumianaki","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"377","DOI":"10.21037\/atm.2018.08.37","article-title":"Technical aspects of bedside respiratory monitoring of transpulmonary pressure","volume":"6","author":"Mojoli","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1046\/j.1442-2050.2002.00224.x","article-title":"Perception of esophageal manometry","volume":"15","author":"Walamies","year":"2002","journal-title":"Dis. Esophagus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1704\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:39:30Z","timestamp":1760135970000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,19]]},"references-count":94,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11061704"],"URL":"https:\/\/doi.org\/10.3390\/jcm11061704","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,19]]}}}