Diaphragm Muscle Thinning in Patients Who Are Mechanically Ventilated

Grosu, Horiana B.; Lee, Young Im; Lee, Jarone; Eden, Edward; Eikermann, Matthias; Rose, Keith

doi:10.1378/chest.11-1638

Cited by 231 publications

(189 citation statements)

References 14 publications

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“…These seminal findings have now been confirmed by other groups, and together, these studies clearly demonstrate that prolonged MV results in the rapid development of both diaphragmatic atrophy and contractile dysfunction in humans (39,42,47). The confirmation that VIDD occurs in humans has accelerated a widespread search for the mechanism(s) responsible for VIDD in hopes of identifying a biological target for drug intervention to prevent or delay VIDD in patients, and this effort continues to the present day as illustrated by the increase in publications in this field (Fig.…”

Section: Ventilator-induced Diaphragm Dysfunction: Historical Overviewsupporting

confidence: 70%

“…This original finding was recently confirmed in another study indicating that diaphragmatic fiber atrophy occurs in humans exposed to full support MV for Ն24 h with the magnitude of the diaphragmatic atrophy being significantly correlated with the duration of MV (47). Additionally, a recent observational study using serial ultrasound measurements to assess diaphragmatic thickness revealed that diaphragm thinning occurs within 48 h after the initiation of partial support MV (39). This study confirmed that diaphragmatic atrophy occurs linearly as a function of time on the ventilator with the rate of atrophy averaging a 6% loss of diaphragm thickness per day of MV.…”

Section: Mv-induced Diaphragm Atrophymentioning

confidence: 61%

“…2, A-C). Furthermore, both human and animal studies reveal that MV-induced diaphragmatic atrophy occurs during both partial (44) and full support MV (33,39,47,58).…”

Section: Mv-induced Diaphragm Atrophymentioning

confidence: 99%

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Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

143

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Powers SK, Wiggs MP, Sollanek KJ, Smuder AJ. Ventilator-induced diaphragm dysfunction: cause and effect. Am J Physiol Regul Integr Comp Physiol 305: R464 -R477, 2013. First published July 10, 2013 doi:10.1152/ajpregu.00231.2013 is used clinically to maintain gas exchange in patients that require assistance in maintaining adequate alveolar ventilation. Common indications for MV include respiratory failure, heart failure, drug overdose, and surgery. Although MV can be a life-saving intervention for patients suffering from respiratory failure, prolonged MV can promote diaphragmatic atrophy and contractile dysfunction, which is referred to as ventilator-induced diaphragm dysfunction (VIDD). This is significant because VIDD is thought to contribute to problems in weaning patients from the ventilator. Extended time on the ventilator increases health care costs and greatly increases patient morbidity and mortality. Research reveals that only 18 -24 h of MV is sufficient to develop VIDD in both laboratory animals and humans. Studies using animal models reveal that MV-induced diaphragmatic atrophy occurs due to increased diaphragmatic protein breakdown and decreased protein synthesis. Recent investigations have identified calpain, caspase-3, autophagy, and the ubiquitin-proteasome system as key proteases that participate in MV-induced diaphragmatic proteolysis. The challenge for the future is to define the MV-induced signaling pathways that promote the loss of diaphragm protein and depress diaphragm contractility. Indeed, forthcoming studies that delineate the signaling mechanisms responsible for VIDD will provide the knowledge necessary for the development of a pharmacological approach that can prevent VIDD and reduce the incidence of weaning problems. respiratory muscle; atrophy; mechanical ventilation; weaning; muscle wasting MECHANICAL VENTILATION (MV) is used clinically to achieve sufficient pulmonary gas exchange in patients unable to sustain adequate alveolar ventilation on their own. Common indications for MV include respiratory failure due to chronic obstructive pulmonary disease, status asthmaticus, and/or heart failure. In addition, MV is often an essential intervention in patients suffering from acute drug overdose, neuromuscular diseases, sepsis, and during surgery along with postsurgical recovery.The number of patients receiving prolonged MV in the United States exceeds more than 300,000 each year in the intensive care unit (ICU) (20). Although MV can be a lifesaving measure, prolonged MV results in the rapid development of diaphragmatic weakness due to both atrophy and contractile dysfunction. This detrimental impact of prolonged MV on the diaphragm has been termed ventilator-induced diaphragmatic dysfunction (VIDD) and VIDD is predicted to be a major contributor to problems in weaning patients from the ventilator (26, 114). Although previous reports describing the impact of prolonged MV on the diaphragm have appeared in the literature, advances in our understanding of the mechanisms responsible for VIDD h...

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Section: Ventilator-induced Diaphragm Dysfunction: Historical Overviewsupporting

confidence: 70%

Section: Mv-induced Diaphragm Atrophymentioning

confidence: 61%

See 1 more Smart Citation

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

143

156

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“…Sus limitaciones residen en la variabilidad inter e intraobservador y en la posibilidad de aplicar el estudio dinámico (excursión diafragmática) solo en pacientes sin VM 67,68,69,70 . Por otra parte, son varios los estudios que han demostrado buena precisión y reproducibilidad de los ultrasonidos en la valoración de la función diafragmática, tanto en voluntarios sanos como en pacientes críticos 52,69 .…”

Section: Ultrasonografíaunclassified

“…El grupo de Grosu encontró un descenso diario del 6% del grosor diafragmático dentro de las primeras 48 h de ventilación mediante modalidades asistidas 67 . En el estudio de Schepens et al, donde la mayoría de pacientes recibían ventilación en modalidad control, este valor fue del 10.9% 71 .…”

Section: Ultrasonografíaunclassified

Disfunción diafragmática: una realidad en el paciente ventilado mecánicamente

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3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 1 ResumenLa afectación muscular del paciente crítico está presente en la mayoría de pacientes que ingresan en el Servicio de Medicina Intensiva (SMI). La alteración, en particular, del músculo diafragmático, inicialmente englobada en esta categoría, se ha diferenciado en los últimos años y se ha demostrado la existencia de una disfunción muscular propia de los pacientes sometidos a ventilación mecánica. En este subgrupo de pacientes, encontramos una disfunción muscular que aparece de manera precoz después del inicio de la ventilación mecánica y que se relaciona, principalmente, con el uso de modalidades control, la presencia de sepsis y/o de fracaso multiorgánico. Aunque se desconoce la etiología concreta que desencadena el proceso, el músculo presenta procesos de estrés oxidativo y alteración mitocondrial, que provocan un desequilibrio en la síntesis proteica, con el resultado de atrofia y alteración de la contractilidad y, como consecuencia, una menor funcionalidad. No fue, de hecho, hasta 2004 cuando Vassilakopoulos et al describieron el término "Disfunción diafragmática asociada a ventilación mecánica" que junto a la lesión por sobre distensión pulmonar y por barotrauma, representan un reto en el día a día de los pacientes ventilados.La disfunción diafragmática tiene influencia en el pronóstico, retardando la extubación, aumentando la estancia hospitalaria y afectando la calidad de vida de estos pacientes en los años siguientes al alta hospitalaria. La ecografía, como técnica no invasiva y accesible en la mayoría de Unidades, podría ser de utilidad en el diagnóstico precoz para iniciar, de forma avanzada, la rehabilitación e influir positivamente en el pronóstico de estos enfermos.Palabras clave: Diafragma, disfunción diafragmática, ventilación mecánica, ecografía. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 *Manuscrito (sin información de autores) AbstractThe critical patient muscle involvement is present in most patients admitted to the intensive care unit (ICU). Specifically the diaphragmatic muscle alteration, initially considered in this category, has been differentiated in recent years, and it has been demonstrated the existence of this muscular dysfunction during mechanical ventilation. In this subgroup of patients, we found that this muscle dysfunction appears at an early stage after the start of mechanical ventilation, which is mainly related to the use of modalities control, and also in presence of sepsis and/or multi-organ failure. Although the specific etiology that triggers the processes unknown, the muscle has processes oxidative stress and mitochond...

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Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults

et al. 2020

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IMPORTANCE Low diaphragm muscle mass at the outset of mechanical ventilation may predispose critically ill patients to poor clinical outcomes. OBJECTIVE To determine whether lower baseline diaphragm thickness (Tdi) is associated with delayed liberation from mechanical ventilation and complications of acute respiratory failure (reintubation, tracheostomy, prolonged ventilation >14 days, or death in the hospital).

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Diaphragm Muscle Thinning in Patients Who Are Mechanically Ventilated

Cited by 231 publications

References 14 publications

Ventilator-induced diaphragm dysfunction: cause and effect

Ventilator-induced diaphragm dysfunction: cause and effect

Disfunción diafragmática: una realidad en el paciente ventilado mecánicamente

Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults

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