Ventilator-induced diaphragm dysfunction in cardiac surgery. Pathomechanisms, characteristics and therapy approaches

Mechanical ventilation is life-saving for patients with respiratory failure or the necessity for deep sedation. The resulting inactivation of the diaphragm has been revealed to induce myofiber atrophy of around 30% after 18 h of mechanical ventilation and a contractile deficit of up to 50%. These profound changes are rooted in a disturbed cellular homeostasis which arises from an increase in oxidative stress and results in cellular apoptosis. This article gives an overview of the major pathomechanisms, the influence of comorbidities in cardiac surgery patients and possible treatment options.