Avoiding Respiratory and Peripheral Muscle Injury During Mechanical Ventilation: Diaphragm-Protective Ventilation and Early Mobilization

Crit Care Clin. 2018 Jul;34(3):357-381. doi: 10.1016/j.ccc.2018.03.005.

Abstract

Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor long-term functional status and quality of life. Major mechanisms of muscle injury include critical illness polymyoneuropathy, sepsis, pharmacologic exposures, metabolic derangements, and excessive muscle loading and unloading. The diaphragm may become weak because of excessive unloading (leading to atrophy) or because of excessive loading (either concentric or eccentric) owing to insufficient ventilator assistance.

Keywords: Intensive care unit; Limb muscle weakness; Mechanical ventilation; Respiratory muscle weakness; Ventilator dependence.

Publication types

  • Review

MeSH terms

  • Atrophy
  • Breathing Exercises
  • Critical Illness
  • Diaphragm / injuries*
  • Diaphragm / pathology
  • Diaphragm / physiopathology
  • Early Ambulation*
  • Electric Stimulation Therapy
  • Extremities / physiopathology
  • Humans
  • Muscle Weakness / etiology
  • Muscle Weakness / pathology
  • Muscle Weakness / prevention & control
  • Muscle Weakness / therapy*
  • Respiration, Artificial / adverse effects*
  • Respiration, Artificial / methods*