Structural differences in the diaphragm of patients following controlled vs assisted and spontaneous mechanical ventilation

Intensive Care Medicine
J Marin-CorralJ R Masclans

Abstract

Ventilator-induced diaphragm dysfunction or damage (VIDD) is highly prevalent in patients under mechanical ventilation (MV), but its analysis is limited by the difficulty of obtaining histological samples. In this study we compared diaphragm histological characteristics in Maastricht III (MSIII) and brain-dead (BD) organ donors and in control subjects undergoing thoracic surgery (CTL) after a period of either controlled or spontaneous MV (CMV or SMV). In this prospective study, biopsies were obtained from diaphragm and quadriceps. Demographic variables, comorbidities, severity on admission, treatment, and ventilatory variables were evaluated. Immunohistochemical analysis (fiber size and type percentages) and quantification of abnormal fibers (a surrogate of muscle damage) were performed. Muscle samples were obtained from 35 patients. MSIII (n = 16) had more hours on MV (either CMV or SMV) than BD (n = 14) and also spent more hours and a greater percentage of time with diaphragm stimuli (time in assisted and spontaneous modalities). Cross-sectional area (CSA) was significantly reduced in the diaphragm and quadriceps in both groups in comparison with CTL (n = 5). Quadriceps CSA was significantly decreased in MSIII compared to BD ...Continue Reading

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Citations

Nov 19, 2019·Current Opinion in Critical Care·Tom Schepens, Jose Dianti
Mar 14, 2020·Critical Care : the Official Journal of the Critical Care Forum·Alice GrassiGiacomo Bellani
Sep 19, 2020·European Respiratory Review : an Official Journal of the European Respiratory Society·Joaquim GeaEsther Barreiro
Jul 30, 2020·Seminars in Respiratory and Critical Care Medicine·Joan Daniel MartíElena Gimeno-Santos
Feb 8, 2021·Journal of Intensive Care·Shinichiro Ohshimo
May 8, 2020·The Journal of Medical Investigation : JMI·Nobuto NakanishiJun Oto

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