Ventilator-induced diaphragm dysfunction: translational mechanisms lead to therapeutical alternatives in the critically ill

Peñuelas, Óscar; Keough, Elena; López‐Rodríguez, Lucía; Carriedo, Demetrio; Gonçalves, Gesly; Barreiro, Esther; Lorente, José A.

doi:10.1186/s40635-019-0259-9

Cited by 47 publications

(48 citation statements)

References 185 publications

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“…Pre‐extubation DTF ≥ 21% has been shown as a good predictor of successful extubation in children 4 . Prolonged ventilation, drugs (steroids, neuromuscular blocking agents, and sedation), and malnutrition are commonly implicated predisposing factors for the development of VIDD 7 …”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Mistri

Dhochak

Jana

et al. 2020

Pediatric Pulmonology

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Rationale The extent of diaphragmatic atrophy and dysfunction in critically ill children from developing countries is not established. Objectives To estimate changes in ultrasound measurements of diaphragmatic thickness over the first week of mechanical ventilation. To assess magnitude and risk factors of diaphragmatic atrophy. Methods In an observational cohort study, children aged 1–18 years, requiring mechanical ventilation were included. Ultrasound measurements of diaphragmatic thickness at end‐expiration (DTe) and end‐inspiration (DTi), and diaphragmatic thickening fraction (DTF) were performed daily during the first week of admission, and pre‐ and post‐extubation. Diaphragmatic atrophy (%) and atrophy rate (rate of decline in DTe, % per day) were calculated. Measurements and Main Results Of 55 children (74.6% boys) enrolled, 20 (36.4%) died. Of 35 children with planned extubation, 5 (14.3%) required reintubation. Baseline median (interquartile range [IQR]) DTe, DTi, and DTF were 1.27 mm (1, 1.6), 1.76 mm (1.35, 2.10), and 33.75% (26.90, 44.60), respectively. There was a significant reduction in DTe over the first week of mechanical ventilation (p < .001), median (IQR) diaphragmatic atrophy and atrophy rate of 9.91% (5.26, 17.35) and 2.01% (1.08, 3.04) per day, respectively. Diaphragmatic atrophy rate was lower in pressure targeted ventilation (n = 44; 1.79% [1.03, 2.87]) than volume targeted ventilation (n = 11; 3.10% [1.31, 5.49]), p = .038. There was no difference in diaphragmatic parameters (atrophy rate, and peri‐extubation DTe and DTF) in extubation success versus failure. Conclusions The diaphragm undergoes progressive atrophy during the first week of mechanical ventilation in critically ill children. Future studies should evaluate ventilation strategies to reduce the diaphragmatic atrophy.

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Section: Introductionmentioning

confidence: 99%

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Mistri

Dhochak

Jana

et al. 2020

Pediatric Pulmonology

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“…Data on the prevalence of diaphragmatic atrophy in children with respiratory failure remain poorly understood, despite a significant number of publications on this clinical problem in adults [4,5]. It is known, that weaning from MV depends on achievement a lot of parameters and the duration of MV is included in this list [6,7].…”

Section: Discussionmentioning

confidence: 99%

Prevention of Respiratory Muscle Dysfunction Due to Diaphragm Atrophy in Children With Respiratory Failure

Filyk

2020

EUREKA: Health Sciences

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The aim of the study was to determine whether diaphragm-protective mechanical ventilation can prevent diaphragm atrophy in children with respiratory failure. Materials and methods. We complete the prospective single-center cohort study. Data analysis included 82 patients 1 month - 18 years old, divided into I group (lung-protective MV) and II group (diaphragm-protective in addition to lung-protective MV). Patients were divided into age subgroups. Stages of the study: 1st day (d1), 3rd (d3), 5th (d5), 7th (d7), 9th (d9), 28th (d28). We studied changes in diaphragm thickness at the end of exhalation and compared them with these indicators at patient`s admission to the study (baseline). Primary endpoint was length of stay in ICU, secondary endpoints were complications (prolonged MV). Results are described as arithmetic mean (X) and standard deviation (σ) with level of significance p. Results. There were significant differences in length of stay in ICU among patients of the 1st and 5th age subgroups: in 1st age subgroup this data was in 1.3 times lower in II group, compared with I group (p <0,05); in 5th age subgroup the situation was the opposite - length of stay in ICU was in 1.4 times higher in II group, compared with I group (p<0.05). There were no patients who required lifelong mechanical ventilation in any of the groups. Changes in the thickness of the diaphragm, which indicate its atrophy, were the most significant among patients of the first, second, third and fourth age subgroups and the severity of atrophy was higher among patients of group I, compared with patients of group II. Conclusions. Diaphragm-protective mechanical ventilation significantly prevents diaphragm atrophy in children with respiratory failure in 2nd, 4th, and 5th age subgroups. Providing goal-directed diaphragm-protective MV might reduce the length of stay in ICU among patients of 1st and 5th age subgroups. There were no observed complications like lifelong mechanical ventilation in both patient`s group.

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“…Most importantly, ventilator settings strongly influence diaphragm atrophy and subsequent diaphragm dysfunction. Thus, diaphragm dysfunction in such cases is termed as ventilator induced diaphragm dysfunction [ 50 ].…”

Section: Muscle Atrophymentioning

confidence: 99%

Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

Nakanishi

Tsutsumi

Hara

et al. 2021

JCM

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Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interconnects the contraction of actin-containing thin filaments and myosin-containing thick filaments. Titin breaks down to form urinary titin N-fragments, which are measurable in urine. Urinary titin N-fragment was originally reported to be a useful biomarker in the diagnosis of muscle dystrophy. Recently, the urinary titin N-fragment has been increasingly gaining attention as a novel biomarker of muscle atrophy and intensive care unit-acquired weakness in critically ill patients, in whom titin loss is a possible pathophysiology. Furthermore, several studies have reported that the urinary titin N-fragment also reflected muscle atrophy and weakness in patients with chronic illnesses. It may be used to predict the risk of post-intensive care syndrome or to monitor patients’ condition after hospital discharge for better nutritional and rehabilitation management. We provide several tips on the use of this promising biomarker in post-intensive care syndrome.

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Ventilator-induced diaphragm dysfunction: translational mechanisms lead to therapeutical alternatives in the critically ill

Cited by 47 publications

References 185 publications

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Diaphragmatic atrophy and dysfunction in critically ill mechanically ventilated children

Prevention of Respiratory Muscle Dysfunction Due to Diaphragm Atrophy in Children With Respiratory Failure

Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

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