Diaphragm-protective mechanical ventilation. Issue 1 (February 2019)

• Record Type: Journal Article
• Authors: Schepens, Tom; Dres, Martin; Heunks, Leo; Goligher, Ewan C.
• Is Part Of: Current opinion in critical care. Volume 25:Issue 1(2019)
• Publication Date: 2019-02
• Subjects: critical illness-associated diaphragm weakness -- diaphragm -- diaphragm myotrauma -- ventilator-induced diaphragm dysfunction; Critical care medicine -- Periodicals; 616.028
• DOI: 10.1097/MCC.0000000000000578
• Languages: English
• ISSNs: 1070-5295

Abstract

Abstract : Purpose of review: Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury – a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy. Recent findings: Mechanical ventilation can cause diaphragm injury (myotrauma) by a variety of mechanisms. An understanding of these various mechanisms raises the possibility of a new approach to ventilatory management, a diaphragm-protective ventilation strategy. Deranged inspiratory effort is the main mediator of diaphragmatic myotrauma; titrating ventilation to maintain an optimal level of inspiratory effort may help to limit diaphragm dysfunction and accelerate liberation of mechanical ventilation. Summary: Mechanical ventilation can cause diaphragm injury and weakness. A novel diaphragm-protective ventilation strategy, avoiding the harmful effects of both excessive and insufficient inspiratory effort, has the potential to substantially improve outcomes for patients.