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Intensive Care Medicine
Published in: Intensive Care Medicine 8/2019

Open Access 01-08-2019 | Review

Expiratory muscle dysfunction in critically ill patients: towards improved understanding

Authors: Zhong-Hua Shi, Annemijn Jonkman, Heder de Vries, Diana Jansen, Coen Ottenheijm, Armand Girbes, Angelique Spoelstra-de Man, Jian-Xin Zhou, Laurent Brochard, Leo Heunks

Published in: Intensive Care Medicine | Issue 8/2019

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Abstract

Introduction

This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists.

Results

The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound.

Conclusion

The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients.
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Metadata
Title
Expiratory muscle dysfunction in critically ill patients: towards improved understanding
Authors
Zhong-Hua Shi
Annemijn Jonkman
Heder de Vries
Diana Jansen
Coen Ottenheijm
Armand Girbes
Angelique Spoelstra-de Man
Jian-Xin Zhou
Laurent Brochard
Leo Heunks
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 8/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05664-4

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