Dysfunction of respiratory muscles in critically ill patients on the intensive care unit.


Autoria(s): Berger, David; Blöchlinger, Stefan; von Haehling, Stephan; Doehner, Wolfram; Takala, Jukka; Z'Graggen, Werner Josef; Schefold, Joerg C.
Data(s)

09/03/2016

Resumo

Muscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed 'ventilator-induced diaphragmatic dysfunction' (VIDD) and should be distinguished from peripheral muscular weakness as observed in 'ICU-acquired weakness (ICU-AW)'. Interestingly, VIDD and ICU-AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross-sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues.

Formato

application/pdf

Identificador

http://boris.unibe.ch/84417/1/Dysfunction.pdf

Berger, David; Blöchlinger, Stefan; von Haehling, Stephan; Doehner, Wolfram; Takala, Jukka; Z'Graggen, Werner Josef; Schefold, Joerg C. (2016). Dysfunction of respiratory muscles in critically ill patients on the intensive care unit. Journal of cachexia, sarcopenia and muscle, 7(4), pp. 403-412. Wiley 10.1002/jcsm.12108 <http://dx.doi.org/10.1002/jcsm.12108>

doi:10.7892/boris.84417

info:doi:10.1002/jcsm.12108

info:pmid:27030815

urn:issn:2190-5991

Idioma(s)

eng

Publicador

Wiley

Relação

http://boris.unibe.ch/84417/

Direitos

info:eu-repo/semantics/openAccess

Fonte

Berger, David; Blöchlinger, Stefan; von Haehling, Stephan; Doehner, Wolfram; Takala, Jukka; Z'Graggen, Werner Josef; Schefold, Joerg C. (2016). Dysfunction of respiratory muscles in critically ill patients on the intensive care unit. Journal of cachexia, sarcopenia and muscle, 7(4), pp. 403-412. Wiley 10.1002/jcsm.12108 <http://dx.doi.org/10.1002/jcsm.12108>

Palavras-Chave #610 Medicine & health
Tipo

info:eu-repo/semantics/article

info:eu-repo/semantics/publishedVersion

PeerReviewed