Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure

被引：164

作者：

Goligher, Ewan C. ^{[1
,7
,8
]}

Brochard, Laurent J. ^{[1
,9
]}

Reid, W. Darlene ^{[1
,2
]}

Fan, Eddy ^{[1
,7
,8
]}

Saarela, Olli ^{[6
]}

Slutsky, Arthur S. ^{[1
,9
]}

Kavanagh, Brian P. ^{[1
,4
,10
]}

Rubenfeld, Gordon D. ^{[1
,11
]}

Ferguson, Niall D. ^{[1
,3
,5
,7
]}

机构：

[1] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[2] Univ Toronto, Dept Phys Therapy, Toronto, ON, Canada

[3] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[4] Univ Toronto, Dept Anesthesia, Toronto, ON, Canada

[5] Univ Toronto, Dept Physiol, Toronto, ON, Canada

[6] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[7] Univ Hlth Network, Div Respirol, Dept Med, Toronto, ON M5G 2N2, Canada

[8] Toronto Gen Hosp, Res Inst, Toronto, ON, Canada

[9] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Ctr Biomed Res, Toronto, ON, Canada

[10] Hosp Sick Children, Dept Crit Care Med, Toronto, ON, Canada

[11] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada

来源：

LANCET RESPIRATORY MEDICINE | 2019年 / 7卷 / 01期

基金：

加拿大健康研究院;

关键词：

CONTROLLED MECHANICAL VENTILATION; INSPIRATORY MUSCLE PRESSURE; PHRENIC-NERVE STIMULATION; CRITICALLY-ILL PATIENTS; ACUTE LUNG INJURY; ATROPHY; DYSFUNCTION; WEAKNESS; TIME; IMPACT;

D O I：

10.1016/S2213-2600(18)30366-7

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Several mechanisms of diaphragm muscle injury (myotrauma) can result in ventilator-induced diaphragm dysfunction, including ventilator over-assistance, under-assistance, eccentric contractions, and end-expiratory shortening. In this Personal View, we summarise the evidence for the clinical relevance of these mechanisms, and present new data based on mediation analysis supporting the hypothesis that myotrauma due to ventilator over-assistance and under-assistance contribute, in part, to the effect of mechanical ventilation on clinical outcomes. The concept of diaphragmatic myotrauma has important implications for research and clinical practice.

引用

页码：90 / 98

页数：9

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