Dysfunction of respiratory muscles in critically ill patients on the intensive care unit.

Berger, David; Blöchlinger, Stefan; von Haehling, Stephan; Doehner, Wolfram; Takala, Jukka; Z'Graggen, Werner Josef; Schefold, Joerg C. (2016). Dysfunction of respiratory muscles in critically ill patients on the intensive care unit. Journal of cachexia, sarcopenia and muscle, 7(4), pp. 403-412. Wiley 10.1002/jcsm.12108

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Muscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed 'ventilator-induced diaphragmatic dysfunction' (VIDD) and should be distinguished from peripheral muscular weakness as observed in 'ICU-acquired weakness (ICU-AW)'. Interestingly, VIDD and ICU-AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross-sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Berger, David; Blöchlinger, Stefan; Takala, Jukka; Z'Graggen, Werner Josef and Schefold, Joerg C.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2190-5991

Publisher:

Wiley

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

28 Jul 2016 16:28

Last Modified:

06 Jan 2017 15:03

Publisher DOI:

10.1002/jcsm.12108

PubMed ID:

27030815

Uncontrolled Keywords:

Cachexia; Diaphragm; ICU‐acquired weakness; Mechanical ventilation; Sepsis; VIDD; Weakness; weaning failure

BORIS DOI:

10.7892/boris.84417

URI:

https://boris.unibe.ch/id/eprint/84417

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