Lipid Overload: Trigger or Consequence of Mitochondrial Oxidative Stress in Ventilator-induced Diaphragmatic Dysfunction?

Abstract

not measurable, but the clinicians felt the patient benefited from parental presence.There were a small but real percentage of responses that expressed concern regarding difficulties in carrying out the procedure (4%), ability to teach (9%), or clinical decision making (5%) while the parent was present. This highlights the importance of having processes in place to address the concerns. These difficulties were more marked with increasing complexity of the procedure and during resuscitation. This reinforces the point of not providing such choices unless the clinician performing the procedure is willing for the parent to be present. It is these scenarios where the parent facilitators could potentially have a bigger role.The patient population in the cohort was from the younger pediatric age group, and the authors acknowledge the limitation of feedback from the patient. The data do not cover all resuscitation scenarios, as parents were not surveyed if the resuscitation was unsuccessful. The work presented is from a single institution, and how it translates to other centers and different cultures is unknown as yet. The process outlined reports a culture of inclusivity of families and strong institutional ethos with champions to promote the cause. For other centers to follow on this model will need a heavy investment in training and education. However, this work can provide a template on which other institutions could implement their tailored program in relation to procedures.Family presence during procedures and resuscitation requires guidelines and a structured approach to ensure success. Curley and colleagues have taken a step in the right direction. They have implemented an education intervention for staff and followed it with evaluating both the parent and the clinical team. The importance of having a designated staff member who has the skill set to emotionally support and continue to assess the parent, as well as to inform and educate, and even to "control" parental movement and behavior should not be underestimated in the success of such an intervention.The clinicians' ability to perform the procedure and exercise clinical decision-making skills is of paramount importance for the quality of care. This issue is also relevant when highly invasive, low-frequency procedures are performed at teaching institutions that are responsible for training clinicians. Having a policy in place assists in addressing these concerns.The policy makers and planners have acknowledged shift from research for the researchers to research for the patient (8), and this article addresses this new focus of patientcentered intervention. Dr. Edward Trudeau's aphorism "To cure sometimes, to relieve often, to comfort always" remains relevant two centuries later.Author disclosures are available with the text of this article at www.atsjournals.org.

Dysfunction of respiratory muscles in critically ill patients on the intensive care unit

“…However, these findings could not be reproduced in biceps muscle specimens . A causative link between lipid overload and mitochondrial dysfunction is not firmly established . Nevertheless, oxidative stress has been linked to activation of apoptic, proteasomal, and autophagocytic pathways, and expression of angiogenetic factors varies with the ventilation mode used …”

“…83 A causative link between lipid overload and mitochondrial dysfunction is not firmly established. 84 Nevertheless, oxidative stress has been linked to activation of apoptic, proteasomal, and autophagocytic pathways, 85 and expression of angiogenetic factors varies with the ventilation mode used. 86 In conclusion, histopathological and biochemical changes of respiratory muscle dysfunction/VIDD in animal models could now be reproduced to some extent in human experiments.…”

Estresse oxidativo na interrupção da ventilação mecânica em pacientes vítimas de traumatismo cranioencefálico: um estudo randomizado e cego

“…Corroborando ainda com esses pressupostos, em um modelo experimental animal realizado com ratos adultos, um grupo de animais foi exposto à ventilação mecânica (VM) por 12 horas e compararam ao grupo controle (não expostos), concluiu-se que a ventilação mecânica promoveu desequilíbrio das principais defesas antioxidantes do diafragma, contribuindo para o dano na musculatura inspiratória 6,20 . Outro estudo com ratos expostos à VM por 18 horas evidenciou diminuição de miofibrila muscular em todos os tipos de fibras diafragmáticas, além de oxidação de proteínas e peroxidação lipídica 6,[21][22][23] .…”

Is Mitochondrial Oxidative Stress the Key Contributor to Diaphragm Atrophy and Dysfunction in Critically Ill Patients?

“…irdly, mitochondrial oxidative stress induces a significant reduction of mitochondrial oxidative phosphorylation and increase of glycolysis, which may lead to an overall reduced energy supply to the muscle [43,55]. Lipid accumulation served as a stimuli to VIDD may result from both the accelerated glycolysis and the decreased breakdown of fatty acids due to compromised mitochondrial function, but the relationship between lipid accumulation and mitochondrial oxidative stress remains unclear [56,57]. Fourthly, mitochondrial oxidative stress modulates activity of enzymes for neurotransmitters in muscle.…”