Mechanical Ventilation‐induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes

@article{Goligher2018MechanicalVD,
  title={Mechanical Ventilation‐induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes},
  author={Ewan C. Goligher and Martin Dres and Eddy Fan and Gordon David Rubenfeld and Damon C. Scales and Margaret S. Herridge and Stefannie Vorona and Michael Chaim Sklar and Nuttapol Rittayamai and Ashley Lanys and Alistair Murray and Deborah Brace and Cristian Urrea and Darlene W. Reid and George Tomlinson and Arthur S Slutsky and Brian P. Kavanagh and Laurent J. Brochard and Niall D. Ferguson},
  journal={American Journal of Respiratory and Critical Care Medicine},
  year={2018},
  volume={197},
  pages={204–213}
}
Rationale: Diaphragm dysfunction worsens outcomes in mechanically ventilated patients, but the clinical impact of potentially preventable changes in diaphragm structure and function caused by mechanical ventilation is unknown. [] Key Method Measurements and Main Results: Of 211 patients enrolled, 191 had two or more diaphragm thickness measurements. Thickness decreased more than 10% in 78 patients (41%) by median Day 4 (interquartile range, 3‐5). Development of decreased thickness was associated with a lower…

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References

SHOWING 1-10 OF 58 REFERENCES
Mechanical Ventilation and Diaphragmatic Atrophy in Critically Ill Patients: An Ultrasound Study
TLDR
In critically ill mechanically ventilated patients, there is a linear relationship between ventilator support and diaphragmatic atrophy rate and at multivariate analysis, only the ventilation support was predictive of diaphagm atrophy rates.
Evolution of Diaphragm Thickness during Mechanical Ventilation. Impact of Inspiratory Effort.
TLDR
Changes in diaphragm thickness are common during mechanical ventilation and may be associated with diaphrasic weakness, and Titrating ventilatory support to maintain normal levels of inspiratory effort may prevent changes in diphragm configuration associated with mechanical ventilation.
The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study
TLDR
Diaphragm atrophy occurs quickly in mechanically ventilated patients and can accurately be monitored using ultrasound, and length of MV, as opposed to other variables, is associated with the degree of atrophy.
Diaphragm Muscle Thinning in Subjects Receiving Mechanical Ventilation and Its Effect on Extubation
TLDR
The thinner the diaphragm at baseline and the greater the extent of diaphagm thinning at 72 h, the greaterThe likelihood of extubation.
Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications
TLDR
Under ACV, diaphragm thickness, EXdi and TFdi were uncorrelated to Ptr,stim and both were predictors of remaining length of MV and ICU and hospital death.
Diaphragm muscle thinning in patients who are mechanically ventilated.
TLDR
Diaphragm muscle thinning starts within 48 h after initiation of MV, however, it is unclear if diaphragmatic thinning correlates with diaphagmatic atrophy or pulmonary function, and the relationship between diphragm thinning and diaphragem strength remains to be elucidated.
Coexistence and Impact of Limb Muscle and Diaphragm Weakness at Time of Liberation from Mechanical Ventilation in Medical Intensive Care Unit Patients
TLDR
Diaphragm dysfunction is twice as frequent as limb muscle weakness and has a direct negative impact on weaning outcome, and limb muscle Weakness was associated with longer duration of MV and hospital stay and the two types of muscle weakness have only limited overlap.
Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation*
TLDR
Using M-mode ultrasonography, diaphragmatic dysfunction was found in a substantial number of medical intensive care unit patients without histories of diaphagmatic disease and showed frequent early and delayed weaning failures.
Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study.
TLDR
A reduced capacity of the diaphragm to produce inspiratory pressure (diaphragM dysfunction) is frequent on ICU admission, associated with sepsis and disease severity, suggesting that it may represent another form of organ failure.
Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure
TLDR
Diaphragm dysfunction is frequent in patients with ICU-acquired weakness but poorly correlated with the ICU's MRC score, and half of the patients who failed the weaning process died during theICU stay.
...
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