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Title
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Diaphragm-protective mechanical ventilation
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Author
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Abstract
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| Purpose of review Diaphragm dysfunction is common in mechanically ventilated patients and predisposes them to prolonged ventilator dependence and poor clinical outcomes. Mechanical ventilation is a major cause of diaphragm dysfunction in these patients, raising the possibility that diaphragm dysfunction might be prevented if mechanical ventilation can be optimized to avoid diaphragm injury - a concept referred to as diaphragm-protective ventilation. This review surveys the evidence supporting the concept of diaphragm-protective ventilation and introduces potential routes and challenges to pursuing this strategy. Recent findings Mechanical ventilation can cause diaphragm injury (myotrauma) by a variety of mechanisms. An understanding of these various mechanisms raises the possibility of a new approach to ventilatory management, a diaphragm-protective ventilation strategy. Deranged inspiratory effort is the main mediator of diaphragmatic myotrauma; titrating ventilation to maintain an optimal level of inspiratory effort may help to limit diaphragm dysfunction and accelerate liberation of mechanical ventilation. Mechanical ventilation can cause diaphragm injury and weakness. A novel diaphragm-protective ventilation strategy, avoiding the harmful effects of both excessive and insufficient inspiratory effort, has the potential to substantially improve outcomes for patients. |
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Language
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English
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Source (journal)
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Current opinion in critical care. - Philadelphia, Pa
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Publication
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Philadelphia
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Lippincott williams & wilkins
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2019
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ISSN
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1070-5295
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DOI
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10.1097/MCC.0000000000000578
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Volume/pages
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25
:1
(2019)
, p. 77-85
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ISI
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000462766700011
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Pubmed ID
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30531536
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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