Expiratory muscle dysfunction in critically ill patients: towards improved understanding

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Introduction: This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists. Results: The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound. Conclusion: The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.
Original languageEnglish
JournalIntensive Care Medicine
DOIs
Publication statusPublished - 2019

Cite this

@article{b695f29873a8436e8a6264db4fe09b19,
title = "Expiratory muscle dysfunction in critically ill patients: towards improved understanding",
abstract = "Introduction: This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists. Results: The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound. Conclusion: The expiratory muscles are the {"}neglected component{"} of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.",
author = "Zhong-Hua Shi and Annemijn Jonkman and {de Vries}, Heder and Diana Jansen and Coen Ottenheijm and Armand Girbes and {Spoelstra-de Man}, Angelique and Jian-Xin Zhou and Laurent Brochard and Leo Heunks",
year = "2019",
doi = "10.1007/s00134-019-05664-4",
language = "English",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Expiratory muscle dysfunction in critically ill patients: towards improved understanding

AU - Shi, Zhong-Hua

AU - Jonkman, Annemijn

AU - de Vries, Heder

AU - Jansen, Diana

AU - Ottenheijm, Coen

AU - Girbes, Armand

AU - Spoelstra-de Man, Angelique

AU - Zhou, Jian-Xin

AU - Brochard, Laurent

AU - Heunks, Leo

PY - 2019

Y1 - 2019

N2 - Introduction: This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists. Results: The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound. Conclusion: The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.

AB - Introduction: This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists. Results: The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound. Conclusion: The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85068106795&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31236639

U2 - 10.1007/s00134-019-05664-4

DO - 10.1007/s00134-019-05664-4

M3 - Review article

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

ER -