RT Journal Article
SR Electronic
T1 Managing respiratory muscle weakness during weaning from invasive ventilation
JF European Respiratory Review
JO EUROPEAN RESPIRATORY REVIEW
FD European Respiratory Society
SP 220205
DO 10.1183/16000617.0205-2022
VO 32
IS 168
A1 Côme Bureau
A1 Marine Van Hollebeke
A1 Martin Dres
YR 2023
UL http://err.ersjournals.com/content/32/168/220205.abstract
AB Weaning is a critical stage of an intensive care unit (ICU) stay, in which the respiratory muscles play a major role. Weakness of the respiratory muscles, which is associated with significant morbidity in the ICU, is not limited to atrophy and subsequent dysfunction of the diaphragm; the extradiaphragmatic inspiratory and expiratory muscles also play important parts. In addition to the well-established deleterious effect of mechanical ventilation on the respiratory muscles, other risk factors such as sepsis may be involved. Weakness of the respiratory muscles can be suspected visually in a patient with paradoxical movement of the abdominal compartment. Measurement of maximal inspiratory pressure is the simplest way to assess respiratory muscle function, but it does not specifically take the diaphragm into account. A cut-off value of −30 cmH2O could identify patients at risk for prolonged ventilatory weaning; however, ultrasound may be better for assessing respiratory muscle function in the ICU. Although diaphragm dysfunction has been associated with weaning failure, this diagnosis should not discourage clinicians from performing spontaneous breathing trials and considering extubation. Recent therapeutic developments aimed at preserving or restoring respiratory muscle function are promising.Weaning is a critical stage of an ICU stay where respiratory muscles play a major role. Estimation of respiratory muscle function is possible by measuring maximal inspiratory pressure and by ultrasound. Promising therapeutic developments are emerging. https://bit.ly/3g1lGwH