title: Diaphragm Dysfunction in Mechanically Ventilated Patients.
abstract: Muscle involvement is found in most critical patients admitted to the intensive care unit (ICU). Diaphragmatic muscle alteration, initially included in this category, has been differentiated in recent years, and a specific type of muscular dysfunction has been shown to occur in patients undergoing mechanical ventilation. We found this muscle dysfunction to appear in this subgroup of patients shortly after the start of mechanical ventilation, observing it to be mainly associated with certain control modes, and also with sepsis and/or multi-organ failure. Although the specific etiology of process is unknown, the muscle presents oxidative stress and mitochondrial changes. These cause changes in protein turnover, resulting in atrophy and impaired contractility, and leading to impaired functionality. The term 'ventilator-induced diaphragm dysfunction' was first coined by Vassilakopoulos et al. in 2004, and this phenomenon, along with injury cause by over-distention of the lung and barotrauma, represents a challenge in the daily life of ventilated patients. Diaphragmatic dysfunction affects prognosis by delaying extubation, prolonging hospital stay, and impairing the quality of life of these patients in the years following hospital discharge. Ultrasound, a non-invasive technique that is readily available in most ICUs, could be used to diagnose this condition promptly, thus preventing delays in starting rehabilitation and positively influencing prognosis in these patients.
authors.affiliation: Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España.
authors.forename: Irene
authors.initials: I
authors.lastname: Dot
authors.affiliation: Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España.
authors.forename: Purificación
authors.initials: P
authors.lastname: Pérez-Teran
authors.affiliation: Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España.
authors.forename: Manuel-Andrés
authors.initials: MA
authors.lastname: Samper
authors.affiliation: Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España; CIBERES, España. Electronic address: jrmasclans@parcdesalutmar.cat.
authors.forename: Joan-Ramon
authors.initials: JR
authors.lastname: Masclans
mesh_terms: D003964:Diaphragm / Q000503:physiopathology*; D006801:Humans; D012121:Respiration, Artificial
keywords: Diafragma; Diaphragm; Diaphragmatic dysfunction; Disfunción diafragmática; Ecografía; Mechanical ventilation; Ultrasound; Ventilación mecánica