Ventilator-induced Diaphragmatic Dysfunction. Dr Bobby King Pamela Youde Nethersole Eastern Hospital, Hong Kong 23 rd December 2011. Mechanical ventilation. Origins of mechanical ventilation. The era of intensive care medicine began with positive-pressure ventilation.
Dr Bobby King
Pamela Youde Nethersole Eastern Hospital, Hong Kong
23rd December 2011
The era of intensive care medicine began with positive-pressure ventilation
The iron lung created negative pressure in abdomen as well as the chest, decreasing cardiac output.
Iron lung polio ward at Rancho Los Amigos Hospital in 1953.
Effects of mechanical ventilation on diaphragmatic contractile properties in rats. Am J Respir Crit Care Med 1994;149(6):1539–1544.
Abnormalities of diaphragmatic muscle in neonates with ventilated lungs. J Pediatr 1988;113(6): 1074–1077.
in 33 mechanically ventilated but clinically stable patients with a variety of underlying diseases,
pressure measured in mechanically ventilated patients were lower than values reported in ambulatory patients with chronic obstructive pulmonary disease
Such marked reduction of the twitch pressure in most of the patients indicates profound respiratory-muscle weakness
Assessment of respiratory output in mechanically ventilated patients. Respir Care Clin N Am 2005;11(2):173–199.
Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. NEngl JMed2008;358:1327–1335.
Atrophy can result from decreased protein synthesis, increased protein degradation, or both
Prolonged duration of CMV (2–4 d), however, results in a different pattern of fiber modification:
Antioxidant supplementation attenuates the deleterious effects of CMV on the diaphragm
structural alterations in the myofibrils were inversely related to force output of the diaphragm
Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med 2004;170(6):626–632.
inhibition of the proteasome pathway may not be an effective way to prevent the loss of contractile force associated with enhanced proteolysis in the diaphragm
At present, the best approach for preventing VIDD is to avoid controlled mechanical ventilation and the use of neuromuscular blocking agents to the greatest extent possible