Critical illness-associated diaphragm weakness

• Published in: Intensive care medicine Vol. 43; no. 10; pp. 1441 - 1452
• Main Authors: Dres, Martin, Goligher, Ewan C., Heunks, Leo M. A., Brochard, Laurent J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2017; Springer; Springer Nature B.V; Springer Verlag
• Subjects: Airway Extubation - adverse effects; Anesthesiology; Canada; Critical Care Medicine; Critical Illness; Diaphragm; Diaphragm (anatomy); Diaphragm - diagnostic imaging; Diaphragm - injuries; Diaphragm - physiopathology; Electromyography; Emergency Medicine; Health aspects; Hospital patients; Humans; Illnesses; Intensive; Intensive care; Intensive Care Units; Life Sciences; Mechanical ventilation; Medicine; Medicine & Public Health; Mortality; Muscle Weakness - etiology; Muscle Weakness - physiopathology; Muscle Weakness - prevention & control; Muscles; Muscular Atrophy - etiology; Muscular Atrophy - physiopathology; Muscular Atrophy - prevention & control; Pain Medicine; Patients; Pediatrics; Pharmacology; Pneumology/Respiratory System; Respiration; Respiration, Artificial - adverse effects; Respiratory Distress Syndrome - complications; Respiratory Distress Syndrome - physiopathology; Review; Risk analysis; Risk Factors; Sepsis; Sepsis - complications; Sepsis - physiopathology; Ultrasonography; Ventilation; Ventilators; Weaning; Canada; Diaphragm atrophy; Respiratory muscle weakness; Diaphragm dysfunction; Critically ill patients
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-017-4928-4

Diaphragm weakness is highly prevalent in critically ill patients. It may exist prior to ICU admission and may precipitate the need for mechanical ventilation but it also frequently develops during the ICU stay. Several risk factors for diaphragm weakness have been identified; among them sepsis and mechanical ventilation play central roles. We employ the term critical illness-associated diaphragm weakness to refer to the collective effects of all mechanisms of diaphragm injury and weakness occurring in critically ill patients. Critical illness-associated diaphragm weakness is consistently associated with poor outcomes including increased ICU mortality, difficult weaning, and prolonged duration of mechanical ventilation. Bedside techniques for assessing the respiratory muscles promise to improve detection of diaphragm weakness and enable preventive or curative strategies. Inspiratory muscle training and pharmacological interventions may improve respiratory muscle function but data on clinical outcomes remain limited.