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
Pages (from-to)1061-1071
Number of pages11
JournalIntensive Care Medicine
Volume45
Issue number8
DOIs
Publication statusPublished - 1 Aug 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.",
keywords = "Acute respiratory failure, Expiratory muscles, Mechanical ventilation, Respiratory muscle monitoring, Respiratory muscle weakness",
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",
month = "8",
day = "1",
doi = "10.1007/s00134-019-05664-4",
language = "English",
volume = "45",
pages = "1061--1071",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "8",

}

Expiratory muscle dysfunction in critically ill patients: towards improved understanding. / Shi, Zhong-Hua; Jonkman, Annemijn; de Vries, Heder; Jansen, Diana; Ottenheijm, Coen; Girbes, Armand; Spoelstra-de Man, Angelique; Zhou, Jian-Xin; Brochard, Laurent; Heunks, Leo.

In: Intensive Care Medicine, Vol. 45, No. 8, 01.08.2019, p. 1061-1071.

Research output: Contribution to journalReview articleAcademicpeer-review

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 - 2019/8/1

Y1 - 2019/8/1

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.

KW - Acute respiratory failure

KW - Expiratory muscles

KW - Mechanical ventilation

KW - Respiratory muscle monitoring

KW - Respiratory muscle weakness

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JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

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ER -