This state-of-the-art review recommends repeated respiratory-effort assessment during high-flow nasal oxygen, CPAP, or bilevel ventilation because acceptable oxygenation may mask excessive effort. It proposes a resource-tiered path from clinical signs to esophageal pressure, ultrasound, and electrical impedance tomography, but no trial shows the framework reduces delayed intubation or mortality.
Key findings
- Clinical signs and simple indices are accessible but nonspecific. Esophageal pressure, respiratory-muscle ultrasound, and electrical impedance tomography add physiological insight but require resources and expertise. NIRS modalities unload differently, and high effort can persist despite acceptable oxygenation, motivating repeated tiered assessment.
Why this matters globally
A resource-tiered framework may bridge technology-rich ICUs and constrained hospitals, but thresholds and action pathways need prospective validation across populations.
Thai researcher contribution
One author lists MORU, Mahidol University within an Austrian-Swiss-Oxford network. This is an international review, not Thai patient data.
Limitations to consider
This is not a systematic review and may be selectively sourced. High effort may mark disease severity rather than cause outcomes; measures are operator-dependent and thresholds unstandardized. Claims that monitoring reduces delayed intubation are physiologic rationale, not intervention-trial results.