Abstract
The diaphragm is vulnerable to injury during mechanical ventilation, and diaphragm dysfunction is both a marker of severity of illness and a predictor of poor patient outcome in the ICU. A combination of factors can result in diaphragm weakness. Both insufficient and excessive diaphragmatic contractile effort can cause atrophy or injury, and recent evidence suggests that targeting an appropriate amount of diaphragm activity during mechanical ventilation has the potential to mitigate diaphragm dysfunction. Several monitoring tools can be used to assess diaphragm activity and function during mechanical ventilation, including pressure-derived parameters, electromyography, and ultrasound. This review details these techniques and presents the rationale for a diaphragm-protective ventilation strategy.
- diaphragm
- respiratory muscles
- muscle weakness
- intensive care
- diagnostic techniques
- respiratory system
- diaphragm dysfunction
- effort-induced lung injury
Footnotes
- Correspondence: Ewan C Goligher MD PhD, Toronto General Hospital, 585 University Ave, Peter Munk Building, 11th Floor, Room 192, Toronto, Ontario, Canada M5G 2N2. E-mail: ewan.goligher{at}utoronto.ca
Dr Schepens is supported in part by the European Respiratory Society, Fellowship STRF October 2018. Dr Goligher is supported by an Early Career Investigator Award from the Canadian Institutes of Health Research, and he has disclosed a relationship with Getinge. Ms Fard has disclosed no conflicts of interest.
Dr Goligher presented a version of this paper at the 58th Respiratory Care Journal Conference, held June 10–11, 2019, in St Petersburg, Florida.
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