Diaphragm weakness and its significance

• Acute respiratory failure is partially due to respiratory muscles inability to meet the demands of respiration that is strained by a medical condition
• Ventilation can have an adverse effect on respiratory muscles even after just 5-6 days (atrophy)

There are several ways to monitor diaphragm strength and function

• Airway pressure and flow waveforms
• Occlusion pressure
• Esophageal pressure waveforms
• Sniff maneuvers
• Ultrasound
• Diaphragm EMG
• Chest xray

Clinical Relevance

• Goal is to use these devices to limit the development of respiratory muscle atrophy because of disuse
• Prevent "overassist" from the ventilator
• Potential use in weaning trials to evaluate for respiratory muscle performance
• This is a new area of intensive care research that could lead to improvements in outcomes

References

Curr Opin Crit Care. 2015 Feb;21(1):34-41. doi: 10.1097/MCC.0000000000000168.

Monitoring and preventing diaphragm injury.

Heunks LM¹, Doorduin J, van der Hoeven JG.