Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2024

Open Access 01-12-2024 | Research

Dyssynchronous diaphragm contractions impair diaphragm function in mechanically ventilated patients

Authors: Benjamin Coiffard, Jose Dianti, Irene Telias, Laurent J. Brochard, Arthur S. Slutsky, Jennifer Beck, Christer Sinderby, Niall D. Ferguson, Ewan C. Goligher

Published in: Critical Care | Issue 1/2024

Login to get access

Abstract

Background

Pre-clinical studies suggest that dyssynchronous diaphragm contractions during mechanical ventilation may cause acute diaphragm dysfunction. We aimed to describe the variability in diaphragm contractile loading conditions during mechanical ventilation and to establish whether dyssynchronous diaphragm contractions are associated with the development of impaired diaphragm dysfunction.

Methods

In patients receiving invasive mechanical ventilation for pneumonia, septic shock, acute respiratory distress syndrome, or acute brain injury, airway flow and pressure and diaphragm electrical activity (Edi) were recorded hourly around the clock for up to 7 days. Dyssynchronous post-inspiratory diaphragm loading was defined based on the duration of neural inspiration after expiratory cycling of the ventilator. Diaphragm function was assessed on a daily basis by neuromuscular coupling (NMC, the ratio of transdiaphragmatic pressure to diaphragm electrical activity).

Results

A total of 4508 hourly recordings were collected in 45 patients. Edi was low or absent (≤ 5 µV) in 51% of study hours (median 71 h per patient, interquartile range 39–101 h). Dyssynchronous post-inspiratory loading was present in 13% of study hours (median 7 h per patient, interquartile range 2–22 h). The probability of dyssynchronous post-inspiratory loading was increased with reverse triggering (odds ratio 15, 95% CI 8–35) and premature cycling (odds ratio 8, 95% CI 6–10). The duration and magnitude of dyssynchronous post-inspiratory loading were associated with a progressive decline in diaphragm NMC (p < 0.01 for interaction with time).

Conclusions

Dyssynchronous diaphragm contractions may impair diaphragm function during mechanical ventilation.

Trial registration

MYOTRAUMA, ClinicalTrials.gov NCT03108118. Registered 04 April 2017 (retrospectively registered).
Appendix
Available only for authorised users
Literature
1.
Goligher EC, Brochard LJ, Reid WD, Fan E, Saarela O, Slutsky AS, Kavanagh BP, Rubenfeld GD, Ferguson ND. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure. Lancet Respir Med. 2019;7(1):90–8.CrossRefPubMed
2.
García-Valdés P, Fernández T, Jalil Y, Peñailillo L, Damiani LF. Eccentric contractions of the diaphragm during mechanical ventilation. Respir care. 2023;68:1757.CrossRefPubMed
3.
Pellegrini M, Hedenstierna G, Roneus A, Segelsjo M, Larsson A, Perchiazzi G. The diaphragm acts as a brake during expiration to prevent lung collapse. Am J Respir Crit Care Med. 2017;195(12):1608–16.CrossRefPubMed
4.
5.
Hashimoto H, Yoshida T, Firstiogusran AMF, Taenaka H, Nukiwa R, Koyama Y, Uchiyama A, Fujino Y. Asynchrony injures lung and diaphragm in acute respiratory distress syndrome. Crit Care Med. 2023;51: e534.CrossRef
6.
Shimatani T, Shime N, Nakamura T, Ohshimo S, Hotz J, Khemani RG. Neurally adjusted ventilatory assist mitigates ventilator-induced diaphragm injury in rabbits. Respir Res. 2019;20(1):293–x.CrossRef
7.
Damiani LF, Engelberts D, Bastia L, Osada K, Katira BH, Otulakowski G, Goligher EC, Reid WD, Dubo S, Bruhn A, Post M, Kavanagh BP, Brochard LJ. Impact of reverse triggering dyssynchrony during lung-protective ventilation on diaphragm function: an experimental model. Am J Respir Crit Care Med. 2022;205(6):663–73.CrossRefPubMed
8.
Gea J, Zhu E, Galdiz JB, Comtois N, Salazkin I, Fiz JA, Grassino A. Functional consequences of eccentric contractions of the diaphragm. Arch Bronconeumol. 2009;45(2):68–74.CrossRefPubMed
9.
Hooijman PE, Beishuizen A, Witt CC, de Waard MC, Girbes AR, Spoelstra-de Man AM, Niessen HW, Manders E, van Hees HW, van den Brom CE, Silderhuis V, Lawlor MW, Labeit S, Stienen GJ, Hartemink KJ, Paul MA, Heunks LM, Ottenheijm CA. Diaphragm muscle fiber weakness and ubiquitin-proteasome activation in critically ill patients. Am J Respir Crit Care Med. 2015;191(10):1126–38.CrossRefPubMedPubMedCentral
10.
Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, Bouyabrine H, Courouble P, Koechlin-Ramonatxo C, Sebbane M, Similowski T, Scheuermann V, Mebazaa A, Capdevila X, Mornet D, Mercier J, Lacampagne A, Philips A, Matecki S. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med. 2011;183(3):364–71.CrossRefPubMed
11.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.CrossRef
12.
Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SB, Lindstrom L. Neural control of mechanical ventilation in respiratory failure. Nat Med. 1999;5(12):1433–6.CrossRefPubMed
13.
Sinderby C, Beck J, Spahija J, Weinberg J, Grassino A. Voluntary activation of the human diaphragm in health and disease. J Appl Physiol. 1998;85(6):2146–58.CrossRefPubMed
14.
Singh B, Panizza JA, Finucane KE. Diaphragm electromyogram root mean square response to hypercapnia and its intersubject and day-to-day variation. J Appl Physiol. 2005;98(1):274–81.CrossRefPubMed
15.
Finucane KE, Panizza JA, Singh B. Efficiency of the normal human diaphragm with hyperinflation. J Appl Physiol. 2005;99(4):1402–11.CrossRefPubMed
16.
Doorduin J, Hees HWH, Hoeven JG, Heunks LMA. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med. 2013;187(1):20–7.CrossRefPubMed
17.
Goldman MD, Grassino A, Mead J, Sears TA. Mechanics of the human diaphragm during voluntary contraction: dynamics. J Appl Physiol Respir Environ Exerc Physiol. 1978;44(6):840–8.PubMed
18.
Grassino A, Goldman MD, Mead J, Sears TA. Mechanics of the human diaphragm during voluntary contraction: statics. J Appl Physiol Respir Environ Exerc Physiol. 1978;44(6):829–39.PubMed
19.
Goligher EC, Laghi F, Detsky ME, Farias P, Murray A, Brace D, Brochard LJ, Bolz S, Rubenfeld GD, Kavanagh BP, Ferguson ND. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med. 2015;41(4):734.CrossRefPubMed
20.
Bellani G, Mauri T, Coppadoro A, Grasselli G, Patroniti N, Spadaro S, Sala V, Foti G, Pesenti A. Estimation of patient’s inspiratory effort from the electrical activity of the diaphragm. Crit Care Med. 2013;41(6):1483–91.CrossRefPubMed
21.
Sinderby C, Liu S, Colombo D, Camarotta G, Slutsky AS, Navalesi P, Beck J. An automated and standardized neural index to quantify patient-ventilator interaction. Crit Care. 2013;17(5):R239.CrossRefPubMedPubMedCentral
22.
Liu L, Xia F, Yang Y, Longhini F, Navalesi P, Beck J, Sinderby C, Qiu H. Neural versus pneumatic control of pressure support in patients with chronic obstructive pulmonary diseases at different levels of positive end expiratory pressure: a physiological study. Crit Care. 2015;19(1):244.CrossRefPubMedPubMedCentral
23.
Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Vorona S, Sklar MC, Rittayamai N, Lanys A, Murray A, Brace D, Urrea C, Reid WD, Tomlinson G, Slutsky AS, Kavanagh BP, Brochard LJ, Ferguson ND. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. Am J Respir Crit Care Med. 2018;197(2):204–13.CrossRefPubMed
24.
Sklar MC, Madotto F, Jonkman A, Rauseo M, Soliman I, Damiani LF, Telias I, Dubo S, Chen L, Rittayamai N, Chen G, Goligher EC, Dres M, Coudroy R, Pham T, Artigas RM, Friedrich JO, Sinderby C, Heunks L, Brochard L. Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients. Crit Care. 2021;25(1):26.CrossRefPubMedPubMedCentral
25.
Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, Rittayamai N, Lanys A, Tomlinson G, Singh JM, Bolz SS, Rubenfeld GD, Kavanagh BP, Brochard LJ, Ferguson ND. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. Am J Respir Crit Care Med. 2015;192(9):1080–8.CrossRefPubMed
26.
Shi Z, van den Berg M, Bogaards S, Conijn S, Paul M, Beishuizen A, Heunks L, Ottenheijm CAC. Replacement fibrosis in the diaphragm of mechanically ventilated critically ill patients. Am J Respir Crit Care Med. 2023;207(3):351–4.CrossRefPubMed
27.
Orozco-Levi M, Lloreta J, Minguella J, Serrano S, Broquetas JM, Gea J. Injury of the human diaphragm associated with exertion and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(9):1734–9.CrossRefPubMed
28.
Lin MC, Ebihara S, El Dwairi Q, Hussain SN, Yang L, Gottfried SB, Comtois A, Petrof BJ. Diaphragm sarcolemmal injury is induced by sepsis and alleviated by nitric oxide synthase inhibition. Am J Respir Crit Care Med. 1998;158(5 Pt 1):1656–63.CrossRefPubMed
29.
Cattapan SE, Laghi F, Tobin MJ. Can diaphragmatic contractility be assessed by airway twitch pressure in mechanically ventilated patients? Thorax. 2003;58(1):58–62.CrossRefPubMedPubMedCentral
30.
Roesthuis LH, Hoeven H, Sinderby C, Frenzel T, Ottenheijm C, Brochard L, Doorduin J, Heunks L. Effects of levosimendan on respiratory muscle function in patients weaning from mechanical ventilation. Intensive Care Med. 2019;45(10):1372–81.CrossRefPubMedPubMedCentral
31.
Doorduin J, Sinderby CA, Beck J, Stegeman DF, Hees HWH, Hoeven JG, Heunks LMA. The calcium sensitizer levosimendan improves human diaphragm function. Am J Respir Crit Care Med. 2012;185(1):90–5.CrossRefPubMed
32.
Doorduin J, Nollet JL, Roesthuis LH, van Hees HW, Brochard LJ, Sinderby CA, van der Hoeven JG, Heunks LM. Partial neuromuscular blockade during partial ventilatory support in sedated patients with high tidal volumes. Am J Respir Crit Care Med. 2017;195(8):1033–42.CrossRefPubMed
33.
Di Mussi R, Spadaro S, Mirabella L, Volta CA, Serio G, Staffieri F, Dambrosio M, Cinnella G, Bruno F, Grasso S. Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV. Crit Care. 2016;20:1.CrossRefPubMed
34.
Bello G, Spinazzola G, Giammatteo V, Montini L, De Pascale G, Bisanti A, Annetta MG, Troiani E, Bianchi A, Pontecorvi A, Pennisi MA, Conti G, Antonelli M. Effects of thyroid hormone treatment on diaphragmatic efficiency in mechanically ventilated subjects with nonthyroidal illness syndrome. Respir Care. 2019;64(10):1199–207.CrossRefPubMed
35.
Crulli B, Kawaguchi A, Praud J, Petrof BJ, Harrington K, Emeriaud G. Evolution of inspiratory muscle function in children during mechanical ventilation. Crit Care. 2021;25(1):1–229.CrossRef
36.
Essouri S, Baudin F, Mortamet G, Beck J, Jouvet P, Emeriaud G. Relationship between diaphragmatic electrical activity and esophageal pressure monitoring in children. Pediatr Crit Care Med. 2019;20(7):e319–25.CrossRefPubMed
37.
Jubran A, Grant BJ, Laghi F, Parthasarathy S, Tobin MJ. Weaning prediction: esophageal pressure monitoring complements readiness testing. Am J Respir Crit Care Med. 2005;171(11):1252–9.CrossRefPubMed
38.
Liu L, Liu H, Yang Y, Huang Y, Liu S, Beck J, Slutsky AS, Sinderby C, Qiu H. Neuroventilatory efficiency and extubation readiness in critically ill patients. Crit Care. 2012;16(4):R143.CrossRefPubMedPubMedCentral
39.
Jansen D, Jonkman AH, Roesthuis LH, Gadgil S, Hoeven JG, Scheffer GJ, Girbes A, Doorduin J, Sinderby CS, Heunks LM. Estimation of the diaphragm neuromuscular efficiency index in mechanically ventilated critically ill patients. Crit Care. 2018;22(1):238.CrossRefPubMedPubMedCentral
Metadata
Title
Dyssynchronous diaphragm contractions impair diaphragm function in mechanically ventilated patients
Authors
Benjamin Coiffard
Jose Dianti
Irene Telias
Laurent J. Brochard
Arthur S. Slutsky
Jennifer Beck
Christer Sinderby
Niall D. Ferguson
Ewan C. Goligher
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2024
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-024-04894-3

Other articles of this Issue 1/2024

Critical Care 1/2024 Go to the issue

Research

Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

Research

Impact of attaining aggressive vs. conservative PK/PD target on the clinical efficacy of beta-lactams for the treatment of Gram-negative infections in the critically ill patients: a systematic review and meta-analysis

Research

Cerebral autoregulation in traumatic brain injury: ultra-low-frequency pressure reactivity index and intracranial pressure across age groups

Research

Gut mycobiome dysbiosis after sepsis and trauma

Perspective

Trajectories of post-traumatic stress in sepsis survivors two years after ICU discharge: a secondary analysis of a randomized controlled trial

Brief Report

Facial appearance associates with longitudinal multi-organ failure: an ICU cohort study