[Comment] Beyond the ventilator: rethinking daily evaluation of respiratory drive and effort

The main goal of current ventilatory strategies in acute respiratory failure is to keep spontaneous breathing whenever clinically appropriate. This approach aims to enhance gas exchange, promote physiological lung aeration, and maintain respiratory muscle function.1 Diaphragm atrophy and atelectasis are frequent complications of respiratory muscle inactivity.2 Changes in respiratory muscle strength and respiratory system mechanics can uncouple respiratory drive from effort, creating a dual risk in which elevated drive might mask harmful effort; conversely, effort alone might hide the severity suggested by excessive drive.