Combined Diaphragm and Limb Muscle Atrophy Is Associated With Increased Mortality in Mechanically Ventilated Patients: A Pilot Study

Carámbula, Agustín; Pereyra, Sebastián; Barbato, Marcelo; Angulo, Martín

doi:10.1016/j.arbr.2020.12.005

Cited by 2 publications

(3 citation statements)

References 15 publications

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“…The authors described atrophy occurring at the hindlimb fast‐twitch muscle tibialis anterior (TA), as well as a decrease in hindlimb contractile force determined in vivo. The pattern of muscle compromise described both in patients with ARDS and in different animal models is highly heterogeneous (Carambula et al, 2021; Divangahi et al, 2004; Shiota et al, 2004). Therefore, we aimed to further investigate the morphologic and functional properties of three different muscles during the course of murine acute lung injury and resolution stages.…”

Section: Discussionmentioning

confidence: 99%

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Peripheral and respiratory muscle impairment during murine acute lung injury

Angulo

Vacca

Rodríguez

et al. 2022

Physiological Reports

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Acute respiratory distress syndrome is associated with skeletal muscle compromise, which decreases survival and impairs functional capacity. A comparative analysis of peripheral and respiratory muscles' atrophy and dysfunction in acute lung injury (ALI) has not been performed. We aimed to evaluate diaphragmatic and peripheral muscle mass and contractility in an ALI animal model. ALI was induced in C57BL/6 mice by intratracheal lipopolysaccharides instillation.Muscle mass and in vitro contractility were evaluated at different time points in hindlimb soleus (slow-twitch) and extensor digitorum longus (EDL, fast-twitch), as well as in the main respiratory muscle diaphragm. Myogenic precursor satellite cell-specific transcription factor Pax7 expression was determined by Western blot. Lung injury was associated with atrophy of the three studied muscles, although it was more pronounced and persistent in the diaphragm. Specific contractility was reduced during lung injury in EDL muscle but restored by the time lung injury has resolved. Specific force was not affected in soleus and diaphragm.A persistent increase in Pax7 expression was detected in diaphragm and EDL muscles after induction of ALI, but not in soleus muscle. Different peripheral and respiratory skeletal muscles are distinctly affected during the course of ALI. Each of the studied muscles presented a unique pattern in terms of atrophy development, contractile dysfunction and Pax7 expression.

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Section: Discussionmentioning

confidence: 99%

“…Different profiles of peripheral and respiratory muscle atrophy and weakness have been described in critically ill patients (Carambula et al, 2021; Dres et al, 2017; Puthucheary et al, 2013). Moreover, diverse muscle groups are affected to different degrees (Campbell et al, 1995; Jung et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Peripheral and respiratory muscle impairment during murine acute lung injury

Angulo

Vacca

Rodríguez

et al. 2022

Physiological Reports

Self Cite

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“…It is often associated with muscle wasting and clinically characterized primarily by generalized, symmetric proximally emphasized extremity weakness ( 22 ). The fact that atrophy of the diaphragm and peripheral muscles in intensive care patients does not necessarily occur together, but can also be observed independently of each other ( 23 ), suggests that the atrophy of both muscle groups also occurs via different mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Diaphragm ultrasound in patients with prolonged weaning from mechanical ventilation

Fritsch,

Siemer,

Dreher

et al. 2024

Quant Imaging Med Surg

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Background Several publications have examined diaphragmatic ultrasound using two-dimensional (2D) parameters in the context of weaning from mechanical ventilation (MV) and extubation. However, the studied cohorts had rather short duration of ventilation. Examinations on patients with prolonged weaning after long-term ventilation were missing. It was the aim of this study to assess of the diaphragm and peripheral musculature of patients undergoing prolonged weaning creating a chronological sequence of ultrasonic parameters during the course of weaning. Methods This study was carried out as a monocentric, prospective observational cross-sectional study. Patients in prolonged weaning who were transferred to a specialized weaning unit were eligible for inclusion if they were ventilated invasively by means of an endotracheal tube or tracheal cannula and if their expected treatment period was at least 5 days. Diaphragmatic function and one representative peripheral muscle were examined in 50 patients between March 2020 and April 2021. The 2D sonographic parameters of diaphragm and diaphragmatic function consisted of diaphragmatic thickness (Tdi) at the end of inspiration and expiration, the fractional thickening (FT) and the diaphragmatic excursion. Additionally, the M. quadriceps femoris was sonographically assessed at two locations. The difference of measurements between the first and the last measuring timepoint were examined using the Wilcoxon signed-rank test. For a longer chronological sequence, the Friedman’s rank sum test with subsequent Wilcoxon-Nemenyi-McDonald-Thompson test for multiple comparisons was carried out. Results Fifty patients with prolonged weaning were included. The median duration of MV before transfer to the weaning unit was 11.5 [interquartile range (IQR) 10] days. Forty-one patients could be assessed over the full course of weaning, with 38 successfully weaned. Within these 41 patients, the sonographic parameters of the diaphragm slightly increased over the course of weaning indicating an increase in thickness and mobility. Especially parameters which represented an active movement reached statistical significance, i.e., inspiratory Tdi when assessed under spontaneous breathing [begin 3.41 (0.99) vs. end 3.43 (1.31) mm; P=0.01] and diaphragmatic excursion [begin 0.7 (0.8) vs. end 0.9 (0.6) cm; P=0.01]. The presence of positive end-expiratory pressure (PEEP) and pressure support did not influence the sonographic parameters significantly. The M. quadriceps femoris, in contrast, decreased slightly but constantly over the time [lower third: begin 1.36 (0.48) vs. end 1.28 (0.36) cm; P=0.054]. Conclusions The present study is the first one to longitudinally analyse diaphragmatic ultrasound in patients with prolonged weaning. Sonographic assessment showed that Tdi and excursion increased over the course of prolonged...

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Combined Diaphragm and Limb Muscle Atrophy Is Associated With Increased Mortality in Mechanically Ventilated Patients: A Pilot Study

Cited by 2 publications

References 15 publications

Peripheral and respiratory muscle impairment during murine acute lung injury

Peripheral and respiratory muscle impairment during murine acute lung injury

Diaphragm ultrasound in patients with prolonged weaning from mechanical ventilation

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