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Diaphragm protection: what should we target?

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Diaphragm weakness affects survival in ventilated patients. A diaphragm-protective ventilation strategy, balancing activity levels, can improve outcomes by preventing muscle injury during mechanical ventilation.

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Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology

Background:

  • Diaphragm weakness is a significant factor impacting survival and comorbidities in mechanically ventilated patients.
  • Mechanical ventilation can cause diaphragm dysfunction, termed myotrauma, through various injury mechanisms.

Purpose of the Study:

  • To review potential targets for diaphragm-protective ventilation strategies.
  • To highlight the importance of monitoring diaphragm activity during mechanical ventilation.

Main Methods:

  • Review of recent evidence on diaphragm activity during mechanical ventilation.
  • Analysis of mechanisms contributing to diaphragm injury and weakness.
  • Discussion of ventilator settings and diaphragm effort.

Main Results:

  • Both absent and excessive diaphragm activity can lead to muscle weakness.
  • Moderate diaphragm activity during mechanical ventilation is associated with improved ICU outcomes.
  • Ventilator overassistance and underassistance can negatively impact diaphragm function.

Conclusions:

  • Implementing a diaphragm-protective ventilation strategy with appropriate diaphragm activity levels can improve clinical outcomes.
  • Monitoring respiratory effort is crucial for optimizing mechanical ventilation and protecting the diaphragm.