Strategies to optimize respiratory muscle function in ICU patients

Abstract

Respiratory muscle dysfunction may develop rapidly in critically ill ventilated patients and is associated with increased morbidity, length of intensive care unit stay, costs, and mortality. This review briefly discusses the pathophysiology of respiratory muscle dysfunction in intensive care unit patients and then focuses on strategies that prevent the development of muscle weakness or, if weakness has developed, how respiratory muscle function may be improved. We propose a simple strategy for how these can be implemented in clinical care.

Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach

“…In the recent systematic review of inspiratory muscle training in ICU patients [22], where "strength" and "endurance" regimes were analyzed separately, both favored inspiratory muscle training relative to control groups. It could be argued that as the inspiratory muscles are primarily muscles of endurance, an endurance-based approach would be sensible [36]. However, in our experience, the highly limited window of patient effort (frequently compromised by fatigue, inattention, or delirium), coupled with the relative disadvantage of potential lung decruitment during sustained training (e.g., secondary to prolonged loss of PEEP), makes strength training a more realistic option for the ICU patient.…”

Physiotherapy in the intensive care unit

“…[1] While a recent review postulates that strategies aimed at improving respiratory muscle function will improve the long-term outcome of survivors, the association between respiratory muscle dysfunction and functional outcomes is unclear. [3] Similarly, despite a focus on facilitating the early mobility of critically ill patients, the effect of these early activities on the outcome of survivors is unclear. A recent trial reported no difference in hospital length of stay or muscle strength at 6 months when comparing in-unit standardised rehabilitation with usual care.…”

Proposal for a New Manual Evaluation Scale for the Diaphragm Muscle: Manual Evaluation of the Diaphragm Scale – MED Scale

“…Mechanical ventilation (MV) is one of life-saving strategies for critical health patients in intensive care unit; in these patients the respiratory system is able to work well due to different pathological causes and conditions (stroke, heart failure, postoperative infections, etc…) [16]. One of the first side effects (occurring after 5-6 days) is the weakness of the diaphragm muscle, with a loss of contractile force of about 32% [17]. As a consequence, morbidity and mortality increase as well as the difficulty in weaning from the MV and the number of new admissions in intensive care [17].…”

“…One of the first side effects (occurring after 5-6 days) is the weakness of the diaphragm muscle, with a loss of contractile force of about 32% [17]. As a consequence, morbidity and mortality increase as well as the difficulty in weaning from the MV and the number of new admissions in intensive care [17]. Causes are not completely clear.…”

“…Causes are not completely clear. A phrenic neuropathy can occur, pointing out the fact that it is not a central issue leading to the strength reduction [17]. Muscle mass is reduced by approximately 25% after a week, with atrophy, altered organization of sarcomeres, autophagic phenomena, and increased catabolism of diaphragmatic muscle fibers [16][17][18].…”