Monitoring respiratory physiology during noninvasive ventilatory support

Effective monitoring is crucial to optimise noninvasive ventilation (NIV) and prevent complications. Built-in software in ventilators provides real-time data on adherence, leaks, tidal volume and apnoea– hypopnoea index, supporting therapy adjustments. Respiratory polygraphy remains the gold standard for detecting patient–ventilator asynchronies and upper airway obstruction in the chronic setting, although its use is often reserved for complex cases. In the acute setting, oesophageal manometry offers detailed insights into respiratory mechanics and patient effort, but it is invasive and has limited application. Ultrasound and surface electromyography are emerging tools to assess diaphragm and respiratory muscle function, with potential applications in NIV monitoring. Innovative approaches like nasal pressure swings, electrical impedance tomography and forced oscillation techniques show promise but require further validation. These methods help address key challenges such as unintentional leaks and variability in ventilator algorithms that have an impact on the accuracy of data interpretation. Integrating advanced monitoring tools with clinical expertise ensures more personalised care and improved outcomes for NIV patients in acute and chronic settings.