title: Respiratory muscle dysfunction: a multicausal entity in the critically ill patient undergoing mechanical ventilation.
abstract: Respiratory muscle dysfunction, particularly of the diaphragm, may play a key role in the pathophysiological mechanisms that lead to difficulty in weaning patients from mechanical ventilation. The limited mobility of critically ill patients, and of the diaphragm in particular when prolonged mechanical ventilation support is required, promotes the early onset of respiratory muscle dysfunction, but this can also be caused or exacerbated by other factors that are common in these patients, such as sepsis, malnutrition, advanced age, duration and type of ventilation, and use of certain medications, such as steroids and neuromuscular blocking agents. In this review we will study in depth this multicausal origin, in which a common mechanism is altered protein metabolism, according to the findings reported in various models. The understanding of this multicausality produced by the same pathophysiological mechanism could facilitate the management and monitoring of patients undergoing mechanical ventilation.
authors.affiliation: Unidad de Cuidados Intensivos, Fundación Valle del Lili, Cali, Colombia; Departamento de Ciencias Fisiológicas, Facultad de Salud, Universidad del Valle, Cali, Colombia.
authors.forename: Magda C
authors.initials: MC
authors.lastname: Díaz
authors.affiliation: Unidad de Cuidados Intensivos, Fundación Valle del Lili, Cali, Colombia; Grupo de Investigación Biomédica de la Universidad ICESI, Cali, Colombia.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Ospina-Tascón
authors.affiliation: Departamento de Ciencias Fisiológicas, Facultad de Salud, Universidad del Valle, Cali, Colombia. Electronic address: bsblasalaz@gmail.com.
authors.forename: Blanca C
authors.initials: BC
authors.lastname: Salazar C
mesh_terms: D015984:Causality; D015897:Comorbidity; D016638:Critical Illness; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D044342:Malnutrition / Q000150:complications / Q000378:metabolism; D015337:Multicenter Studies as Topic; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D011446:Prospective Studies; D059748:Proteolysis; D012121:Respiration, Artificial / Q000009:adverse effects; D012132:Respiratory Muscles / Q000503:physiopathology*; D012133:Respiratory Paralysis / Q000209:etiology* / Q000503:physiopathology; D015300:Ventilator Weaning
chemical_list: D005938:Glucocorticoids; D009466:Neuromuscular Blocking Agents
keywords: Critical patient; Destete de la ventilación mecánica; Disfunción respiratoria; Mechanical ventilation; Paciente crítico; Protein synthesis and malnutrition in the critically ill patient; Proteolysis; Proteólisis; Respiratory muscle dysfunction; Sepsis; Síntesis de proteínas y desnutrición en el paciente crítico; Ventilación mecánica; Weaning from mechanical ventilation