scholarly journals VENTILATOR-INDUCED DIAPHRAGMATIC DYSFUNCTION: MODIFIABLE CAUSES OF INJURY AND CORRELATED OUTCOMES

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2513
Author(s):  
Jan Fouad ◽  
Lauren Killingsworth ◽  
Margaret Pisani
Keyword(s):  
Diaphragmatic Dysfunction

scholarly journals Transcriptome profiling of the diaphragm in a controlled mechanical ventilation model reveals key genes involved in ventilator-induced diaphragmatic dysfunction

BMC Genomics ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ruining Liu ◽  
Gang Li ◽  
Haoli Ma ◽  
Xianlong Zhou ◽  
Pengcheng Wang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Signaling Pathway ◽  
Wistar Rats ◽  
Cholesterol Metabolism ◽  
Expression Profiles ◽  
Receptor Interaction ◽  
Pathophysiological Mechanism ◽  
Rna Seq ◽  
Diaphragmatic Dysfunction ◽  
Controlled Mechanical Ventilation

Abstract Background Ventilator-induced diaphragmatic dysfunction (VIDD) is associated with weaning difficulties, intensive care unit hospitalization (ICU), infant mortality, and poor long-term clinical outcomes. The expression patterns of long noncoding RNAs (lncRNAs) and mRNAs in the diaphragm in a rat controlled mechanical ventilation (CMV) model, however, remain to be investigated. Results The diaphragms of five male Wistar rats in a CMV group and five control Wistar rats were used to explore lncRNA and mRNA expression profiles by RNA-sequencing (RNA-seq). Muscle force measurements and immunofluorescence (IF) staining were used to verify the successful establishment of the CMV model. A total of 906 differentially expressed (DE) lncRNAs and 2,139 DE mRNAs were found in the CMV group. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to determine the biological functions or pathways of these DE mRNAs. Our results revealed that these DE mRNAs were related mainly related to complement and coagulation cascades, the PPAR signaling pathway, cholesterol metabolism, cytokine-cytokine receptor interaction, and the AMPK signaling pathway. Some DE lncRNAs and DE mRNAs determined by RNA-seq were validated by quantitative real-time polymerase chain reaction (qRT-PCR), which exhibited trends similar to those observed by RNA-sEq. Co-expression network analysis indicated that three selected muscle atrophy-related mRNAs (Myog, Trim63, and Fbxo32) were coexpressed with relatively newly discovered DE lncRNAs. Conclusions This study provides a novel perspective on the molecular mechanism of DE lncRNAs and mRNAs in a CMV model, and indicates that the inflammatory signaling pathway and lipid metabolism may play important roles in the pathophysiological mechanism and progression of VIDD.

Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review

2016 ◽  
Vol 43 (1) ◽  
pp. 29-38 ◽  
Author(s):  
Massimo Zambon ◽  
Massimiliano Greco ◽  
Speranza Bocchino ◽  
Luca Cabrini ◽  
Paolo Federico Beccaria ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Critically Ill Patient ◽  
Diaphragmatic Dysfunction

Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery

2022 ◽  
pp. rapm-2021-102962
Author(s):  
Constantin Robles ◽  
Nick Berardone ◽  
Steven Orebaugh
Keyword(s):  
Total Sample ◽  
Shoulder Surgery ◽  
Diaphragmatic Paralysis ◽  
Postanesthesia Care Unit ◽  
Phrenic Nerve Palsy ◽  
Diaphragmatic Dysfunction ◽  
Postoperative Assessment ◽  
Respiratory Parameters ◽  
Breath Sounds ◽  
Arthroscopic Shoulder Surgery

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing the block more distally, at the level of the superior trunk, may reduce the incidence of phrenic nerve palsy. We hypothesized that superior trunk block would result in diaphragmatic paralysis rate of less than 20%.Methods30 patients undergoing arthroscopic shoulder surgery received superior trunk block under ultrasound guidance. Measurements of diaphragm excursion were determined with ultrasound prior to the block, 15 min after the block, and postoperatively in phase II of postanesthesia care unit, in conjunction with clinical parameters of respiratory function.Results10 patients (33.3%, 95% CI 17.3% to 52.8%) developed complete hemidiaphragmatic paralysis at the postoperative assessment. An additional eight patients (26.7%) developed paresis without paralysis. Of the 18 patients with diaphragm effects, seven (38.9%) reported dyspnea. 83.3% of patients with abnormal diaphragm motion (56.7% of the total sample) had audibly reduced breath sounds on auscultation. Oxygen saturation measurements did not correlate with diaphragm effect and were not significantly reduced by the postoperative assessment.ConclusionAlthough injection of local anesthetic at the superior trunk level is associated with less diaphragmatic paralysis compared with traditional interscalene block, a significant portion of patients will continue to have ultrasonographic and clinical evidence of diaphragmatic weakness or paralysis.

scholarly journals The Prospects of Succinates’ Use under Hypoxic Conditions in COVID-19

2021 ◽  
Vol 66 (1-2) ◽  
pp. 65-74
Author(s):  
Yu. Р. Orlov ◽  
V. V. Afanasyev ◽  
I. A. Khilenko
Keyword(s):  
Clinical Studies ◽  
Multiple Organ ◽  
Tissue Hypoxia ◽  
Diaphragmatic Dysfunction ◽  
Pathogenetic Role ◽  
Domestic Literature ◽  
Hypoxic Conditions ◽  
Number Of Patients ◽  
Positive Effect

The aim of the work was the search for materials from experimental and clinical studies reflecting the pathogenetic role of the possible use of succinates for the correction of hypoxia in COVID-19. Materials and methods. 79 foreign and domestic literature sources were analyzed concerning the pathogenesis of COVID-19 and the pathogenetic role of succinates in hypoxia under conditions of COVID-19, oxidative stress, and diaphragmatic dysfunction were analyzed. The literature search was carried out using Pubmed and ELIBRARY.ru databases. Results. As the analysis of the literature has shown, tissue hypoxia is the basis of COVID-19 pathogenesis, triggering the entire cascade of  pathomorphological events leading to the development of multiple organ failure. A number of experimental and clinical studies (on a fairly large number of patients) reflect the positive effect of tissue hypoxia correction using succinates, both in adult patients and in children with a different spectrum of pathology associated with acute respiratory failure syndrome. Conclusion. Analysis of literature data allows to substantiate the prospect of using preparations containing succinate (reamberin, cytoflavin) in the complex therapy of severe cases of COVID-19. 

scholarly journals Feasability of Diaphragmatic Speckle Tracking In Intensive Care Units

2021 ◽  
Author(s):  
Michael Poette ◽  
Laure Crognier ◽  
Fanny Vardon-Bounes ◽  
Stéphanie Ruiz ◽  
Bernard Georges ◽  
...  
Keyword(s):  
Intensive Care ◽  
Strain Rate ◽  
Intensive Care Units ◽  
Strongly Correlated ◽  
Diaphragmatic Dysfunction ◽  
Good Reliability ◽  
Diaphragmatic Function ◽  
Strain And Strain Rate ◽  
Measured Strain ◽  
The Right

Abstract Background: Diaphragmatic dysfunction is a common condition in intensive care units (ICU). Its presence correlates with prolonged weaning from mechanical ventilation and mortality. Diaphragmatic excursion (EXdi) and thickening fraction (TFdi) are the 2 main measures currently described in diaphragmatic ultrasound, but each has its limitations. Strain and strain rate are already used cardiac sonography and could be of interest in the assessment of diaphragmatic function in ICU. The aim of this work was to evaluate the feasibility of diaphragmatic strain and strain rate in ICU and to describe their distribution, reproducibility and agreement with existing parameters. Methods: All patients who underwent a T-tube weaning test were prospectively included. Ultrasound loops were recorded on each side of the patient during the last 30 minutes of the weaning test. Two operators measured strain, strain rate, EXdi, and TFdi blind to each other in post-treatment analysis. Results: Thirty patients were analyzed. The median values for strain and strain rate were -6.74% and -0.23.s-1 on the left side and -8.17% and -0.22.s-1 on the right side. Concerning strain and strain rate, intra-class coefficients showed systematically a very good reliability between operators. Conclusion: Diaphragmatic strain and strain rate measurements appeared feasible in an ICU environment and seemed reproducible and not strongly correlated with EXdi and TFdi. An improvement of the analysis software is needed to improve the ease of interpretation. The interest of these parameters in clinical practice should be explored in forthcoming studies.

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