title: Monitoring and preventing diaphragm injury.
abstract: OBJECTIVE
  The present review summarizes developments in the field of respiratory muscle monitoring, in particular in critically ill patients.
  
  
  RESULTS
  Patients admitted to the ICU may develop severe respiratory muscle dysfunction in a very short time span. Among other factors, disuse and sepsis have been associated with respiratory muscle dysfunction in these patients. Because weakness is associated with adverse outcome, including prolonged mechanical ventilation and mortality, it is surprising that respiratory muscle dysfunction largely develops without being noticed by the clinician. Respiratory muscle monitoring is not standard of care in most ICUs. Improvements in technology have opened windows for monitoring the respiratory muscles in critically ill patients. Diaphragm electromyography and esophageal pressure measurement are feasible techniques for respiratory muscle monitoring, although the effect on outcome remains to be investigated.
  
  
  CONCLUSIONS
  Respiratory muscle dysfunction develops rapidly in selected critically ill patients and is associated with adverse outcome. Recent technological advances allow real-time monitoring of respiratory muscle activity in these patients. Although this field is in its infancy, from a physiological perspective, it is reasonable to assume that monitoring respiratory muscle activity improves outcome in these patients.
authors.affiliation: Department of Critical Care Medicine, Radboudumc, Nijmegen, The Netherlands.
authors.forename: Leo M A
authors.initials: LM
authors.lastname: Heunks
authors.forename: Jonne
authors.initials: J
authors.lastname: Doorduin
authors.forename: Johannes G
authors.initials: JG
authors.lastname: van der Hoeven
mesh_terms: D016638:Critical Illness / Q000628:therapy; D003964:Diaphragm / Q000503:physiopathology*; D004576:Electromyography; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000379:methods*; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy; D012132:Respiratory Muscles / Q000503:physiopathology*; D018805:Sepsis / Q000150:complications; D015300:Ventilator Weaning / Q000379:methods