Diaphragm-protective mechanical ventilation

Tom Schepens, Martin Dres, Leo Heunks, Ewan C. Goligher

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

PURPOSE OF REVIEW: Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury - a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy. RECENT FINDINGS: Mechanical ventilation can cause diaphragm injury (myotrauma) by a variety of mechanisms. An understanding of these various mechanisms raises the possibility of a new approach to ventilatory management, a diaphragm-protective ventilation strategy. Deranged inspiratory effort is the main mediator of diaphragmatic myotrauma; titrating ventilation to maintain an optimal level of inspiratory effort may help to limit diaphragm dysfunction and accelerate liberation of mechanical ventilation. SUMMARY: Mechanical ventilation can cause diaphragm injury and weakness. A novel diaphragm-protective ventilation strategy, avoiding the harmful effects of both excessive and insufficient inspiratory effort, has the potential to substantially improve outcomes for patients.
LanguageEnglish
Pages77-85
JournalCurrent Opinion in Critical Care
Volume25
Issue number1
DOIs
Publication statusPublished - 2019

Cite this

Schepens, Tom ; Dres, Martin ; Heunks, Leo ; Goligher, Ewan C. / Diaphragm-protective mechanical ventilation. In: Current Opinion in Critical Care. 2019 ; Vol. 25, No. 1. pp. 77-85.
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Diaphragm-protective mechanical ventilation. / Schepens, Tom; Dres, Martin; Heunks, Leo; Goligher, Ewan C.

In: Current Opinion in Critical Care, Vol. 25, No. 1, 2019, p. 77-85.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - Heunks, Leo

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AB - PURPOSE OF REVIEW: Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury - a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy. RECENT FINDINGS: Mechanical ventilation can cause diaphragm injury (myotrauma) by a variety of mechanisms. An understanding of these various mechanisms raises the possibility of a new approach to ventilatory management, a diaphragm-protective ventilation strategy. Deranged inspiratory effort is the main mediator of diaphragmatic myotrauma; titrating ventilation to maintain an optimal level of inspiratory effort may help to limit diaphragm dysfunction and accelerate liberation of mechanical ventilation. SUMMARY: Mechanical ventilation can cause diaphragm injury and weakness. A novel diaphragm-protective ventilation strategy, avoiding the harmful effects of both excessive and insufficient inspiratory effort, has the potential to substantially improve outcomes for patients.

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