Functional Consequences of Eccentric Contractions of the Diaphragm

Gea, J.; Zhu, Ercheng; Gáldiz, Juan B.; Comtois, Norman; Salazkin, Igor; Fiz, J.A.; Grassino, A.

doi:10.1016/s1579-2129(09)70777-3

Cited by 24 publications

(22 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A similar immature myofibrillar structure of the diaphragm would contribute to the significantly greater susceptibility to stretch‐induced muscle damage at 75 days postconceptional age. Eccentric diaphragm contractions in vivo produce persistent deterioration of contractile function and are associated with sarcomeric and sarcolemmal damage 20. Similar evidence of muscle damage has been observed following periods of inspiratory resistive loading21, 22 which is known to heavily recruit the diaphragm 23.…”

Section: Discussionmentioning

confidence: 79%

Developmental changes in diaphragm muscle function in the preterm and postnatal lamb

Lavin

Song

Bakker

et al. 2013

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 79%

Developmental changes in diaphragm muscle function in the preterm and postnatal lamb

Lavin

Song

Bakker

et al. 2013

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…This was occurring as the diaphragm was still activated and neural inspiration was continuing. This situation could possibly be interpreted as an eccentric contraction of the diaphragm, which could potentially lead to structural damage of the diaphragm and a rapid decline in force, as reported in an animal model (24).…”

Section: Nava In Infantsmentioning

confidence: 83%

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

et al. 2012

View full text Add to dashboard Cite

Background: Neurally adjusted ventilatory assist (NaVa) is a mode of ventilation controlled by the electrical activity of the diaphragm (edi). The aim was to evaluate patient-ventilator interaction in infants during NaVa as compared with conventional ventilation. Methods: Infants were successively ventilated with NaVa, pressure control ventilation (PcV), and pressure support ventilation (PsV). edi and ventilator pressure (Pvent) waveforms were compared and their variability was assessed by coefficients of variation. results: Ten patients (mean age 4.3 ± 2.4 mo and weight 5.9 ± 2.2 kg) were studied. In PcV and PsV, 4 ± 4.6% and 6.5 ± 7.7% of the neural efforts failed to trigger the ventilator. This did not occur during NaVa. Trigger delays were shorter with NaVa as compared with PcV and PsV (93 ± 20 ms vs. 193 ± 87 ms and 135 ± 29 ms). During PcV and PsV, the ventilator cycled off before the end of neural inspiration in 12 ± 13% and 21 ± 19% of the breaths (0 ± 0% during NaVa). During PcV and PsV, 24 ± 11% and 25 ± 9% of the neural breath cycle was asynchronous with the ventilator as compared with 11 ± 3% with NaVa. a large variability was observed for edi in all modes, which was transmitted into Pvent during NaVa (coefficient of variation: 24 ± 8%) and not in PcV (coefficient of variation 2 ± 1%) or PsV (2 ± 2%). conclusion: NaVa improves patient-ventilator interaction and delivers adequate ventilation with variable pressure in infants.c onventional modes of mechanical ventilation are clearly limited in their ability to provide synchrony between the patient and the assist delivered, as demonstrated repeatedly in adults (1,2) and more recently in children (3). Patientventilator asynchrony has been associated with poor clinical outcome (1,2,4). Despite the attempt to improve synchrony with "patient-triggered" modes such as pressure control ventilation (PCV) or pressure support ventilation (PSV), 25% of adult patients show more than 10% asynchrony with the ventilator (1,2,5). In pediatric patients, synchrony is particularly difficult to achieve because of the small tidal volumes, high respiratory rates, and weak airway flows and pressures. Ironically, during synchronized intermittent mandatory ventilation, more than half of the patient's breathing cycle is spent in asynchrony (3) with the ventilator.Besides the poor timing between the patient and the ventilator, patient-ventilator asynchrony also includes the inability of the ventilator to respond to patient demand and the natural breath-to-breath variability. Respiratory variability is a sign of a well functioning respiratory system (6). By definition, PCV and PSV deliver fixed levels of assist, thereby offering no possibility to respond to the patient's respiratory demand and variability.Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that delivers assist in time and in proportion to the electrical activity of the diaphragm (Edi) on a breath-by-breath basis (7). Numerous studies have shown that NAVA efficiently unloads the respirat...

show abstract

“…The concept of load-induced diaphragm injury may explain recent ultrasound findings demonstrating increased diaphragm thickness during the course of mechanical ventilation in patients with high inspiratory efforts [23]. In addition to high breathing effort, patientventilator dyssynchronies, especially eccentric (lengthening) contractions, may promote load-induced diaphragm injury [24]. Whether eccentric contractions are sufficiently severe and frequent to contribute to diaphragm injury in intensive care unit (ICU) patients is not yet known.…”

Section: Diaphragm Load-induced Injurymentioning

confidence: 99%

Physiology of the Respiratory Drive in ICU Patients: Implications for Diagnosis and Treatment

2020

View full text Add to dashboard Cite

show abstract

Functional Consequences of Eccentric Contractions of the Diaphragm

Cited by 24 publications

References 31 publications

Developmental changes in diaphragm muscle function in the preterm and postnatal lamb

Developmental changes in diaphragm muscle function in the preterm and postnatal lamb

Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation

Physiology of the Respiratory Drive in ICU Patients: Implications for Diagnosis and Treatment

Contact Info

Product

Resources

About