Visualization and monitoring of the upper airway during non- invasive respiratory therapies

Upper airway obstruction (UAO) remains a critical barrier to the success of non-invasive respiratory therapies (NIRT) and mechanical in-exsufflation, particularly in patients with amyotrophic lateral sclerosis, where unmanaged events significantly reduce survival.This review examines the complex pathophysiology of UAO, detailing mechanisms such as epiglottic collapse, soft palate narrowing, and therapy-induced obstructions often exacerbated by oronasal interfaces.We evaluate diagnostic modalities, contrasting traditional ventilator data and polysomnography with the gold standard: transnasal fiberoptic videolaryngoscopy (TFL).Furthermore, we highlight emerging, less invasive techniques such as laryngeal ultrasound and electrical impedance tomography for real-time monitoring.Effective management necessitates precise, site-specific titration protocols, including interface switching and pressure adjustments, informed by direct visualization or flow waveform analysis.Ultimately, integrating visual assessment into clinical practice is essential for optimizing therapy adherence and improving outcomes in patients with complex airway dynamics.