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Diaphragm Dysfunction

V I Belokonev, S Yu Pushkin
AIM: To analyze clinical course and develop surgical technique for thoracoabdominal hernia in patients after previous sterno-mediastinitis. MATERIAL AND METHODS: There were 7 (20%) patients aged 53-69 years with thoracoabdominal hernia after previous cardiac surgery followed by postoperative sterno-mediastinitis. Thoracoomentoplasty was used for treatment of this complication. There were 2 males and 5 females. RESULTS: All patients underwent surgery aimed at translocation of the organs from mediastinum to abdominal cavity, restoring normal anatomical location of stomach, transverse colon and large omentum, stabilizing the thorax and closing the defects in the diaphragm and anterior abdominal wall...
2019: Khirurgiia
J Marin-Corral, I Dot, M Boguña, L Cecchini, A Zapatero, M P Gracia, S Pascual-Guardia, C Vilà, A Castellví, P Pérez-Terán, J Gea, J R Masclans
PURPOSE: Ventilator-induced diaphragm dysfunction or damage (VIDD) is highly prevalent in patients under mechanical ventilation (MV), but its analysis is limited by the difficulty of obtaining histological samples. In this study we compared diaphragm histological characteristics in Maastricht III (MSIII) and brain-dead (BD) organ donors and in control subjects undergoing thoracic surgery (CTL) after a period of either controlled or spontaneous MV (CMV or SMV). METHODS: In this prospective study, biopsies were obtained from diaphragm and quadriceps...
February 21, 2019: Intensive Care Medicine
Pedram Talebian, Mohammad Kermansaravi, Abdolreza Pazouki, Ali Kabir
Diaphragm paralysis has been observed following cervical spinal cord and diaphragm injuries. Patients with diaphragm paralysis require plication of the diaphragm if significant pulmonary dysfunction occurs. We aimed to report the unsuccessful stapling technique in the correction of diaphragm paralysis. We report a 49-year-old man with unilateral diaphragmatic paralysis, who underwent laparoscopic resection of the diaphragm using staplers. He then underwent thoracotomy with mesh reinforcement due to the unsuccessful initial procedure...
January 2019: Videosurgery and Other Miniinvasive Techniques
Luigi Vetrugno, Giovanni Maria Guadagnin, Federico Barbariol, Nicola Langiano, Alberto Zangrillo, Tiziana Bove
Of the various muscles that make up the respiratory system, the diaphragm is the prima donna. In the past, only specialist research centers were able to estimate and challenge the effort of this muscle; this was achieved by measuring transdiaphragmatic pressure-an invasive technique involving a double-balloon probe inserted through the esophagus-or by measuring twitch pressure (ie, the pressure generated at the outside tip of the endotracheal tube). However, the prevalence of diaphragm dysfunction in critically ill patients requiring intubation can exceed 60% (at the time of hospital admission) and may rise to as high as 80% in patients requiring prolonged mechanical ventilation and experiencing difficult weaning...
January 4, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Zhihua Lu, Huiqing Ge, Lilong Xu, Feng Guo, Ge Zhang, Yinshan Wu
PURPOSE: To assess alteration of diaphragmatic function by ultrasonography in a population of mechanically ventilated patients with or without sepsis. METHODS: We performed a prospective, 6-month, single-center, observational cohort study. Mechanically ventilated septic and nonseptic patients were studied within 24 hours following intubation and before the moment of ventilator liberation. Diaphragm thickness and contractile activity (quantified by diaphragmatic thickening fraction, DTF) were measured by ultrasonography at the zone of apposition...
January 22, 2019: Journal of Clinical Ultrasound: JCU
Vanessa Zambelli, Anna Sigurtà, Laura Rizzi, Letizia Zucca, Paolo Delvecchio, Elena Bresciani, Antonio Torsello, Giacomo Bellani
BACKGROUND: Ventilator-induced diaphragmatic dysfunction (VIDD) is a common event during mechanical ventilation (MV) leading to rapid muscular atrophy and contractile dysfunction. Recent data show that renin-angiotensin system is involved in diaphragmatic skeletal muscle atrophy after MV. In particular, angiotensin-II can induce marked diaphragm muscle wasting, whereas angiotensin-(1-7) (Ang-(1-7)) could counteract this activity. This study was designed to evaluate the effects of the treatment with Ang-(1-7) in a rat model of VIDD with neuromuscular blocking agent infusion...
January 18, 2019: Intensive Care Medicine Experimental
Douglas Evans, Deborah Shure, Linda Clark, Gerard J Criner, Martin Dres, Marcelo Gama de Abreu, Franco Laghi, David McDonagh, Basil Petrof, Teresa Nelson, Thomas Similowski
BACKGROUND: Mechanical ventilation (MV) is a life-saving technology that restores or assists breathing. Like any treatment, MV has side effects. In some patients it can cause diaphragmatic atrophy, injury, and dysfunction (ventilator-induced diaphragmatic dysfunction, VIDD). Accumulating evidence suggests that VIDD makes weaning from MV difficult, which involves increased morbidity and mortality. METHODS AND ANALYSIS: This paper describes the protocol of a randomized, controlled, open-label, multicenter trial that is designed to investigate the safety and effectiveness of a novel therapy, temporary transvenous diaphragm pacing (TTVDP), to improve weaning from MV in up to 88 mechanically ventilated adult patients who have failed at least two spontaneous breathing trials over at least 7 days...
January 17, 2019: Trials
C Dumoulin, L Pazzoto Cacciari, J Mercier
Female pelvic floor muscles form a diaphragm that spans the entire pelvic cavity. They consist of the fibers of the coccygeus and the levator ani muscles, the latter of which is composed of five parts. Together with their fascia, the pelvic floor muscles provide support for the urethra, the vagina, and the rectum and constrict the urethral, vaginal, and anal orifices. Alterations in the composition of the pelvic floor muscles at menopause appear to affect their properties and, thereby, their ability to function adequately...
January 17, 2019: Climacteric: the Journal of the International Menopause Society
Andrea Boccatonda, Valentina Decorato, Giulio Cocco, Stefano Marinari, Cosima Schiavone
Background: Some previous works have tested LUS use in diagnosing and monitoring interstitial lung diseases. B-lines are main sonographic signs for interstitial diseases. Increasing evidences suggest that dyspnea and impaired exercise capacity in IPF patients can be related, at least in part, to respiratory muscle dysfunction, in particular to diaphragm functionality. Both B-mode and M-mode ultrasound techniques have been employed to assess diaphragm excursion (DE), which measures the distance that the diaphragm is able to move during the respiratory cycle...
2019: Multidisciplinary Respiratory Medicine
Teng-Jen Yu, Yu-Chih Liu, Chien-Min Chu, Han-Chung Hu, Kuo-Chin Kao
Mechanical ventilation may cause diaphragm weakness an effect termed ventilator-induced diaphragm dysfunction (VIDD). The prevalence of VIDD among patients receiving mechanical ventilation is very high, with the degree of diaphragmatic atrophy being associated with the length of mechanical ventilation. Theophylline is known to increase diaphragmatic contractility and reduce fatigue, so in this study, we evaluated the effect of theophylline in patients with prolonged mechanical ventilation.Patients who depended on mechanical ventilation were included in the study...
January 2019: Medicine (Baltimore)
P R van Urk, A S Littooij, J P J van Gestel, M C Kruyt
Compression of the celiac artery by a tight arcuate ligament of the diaphragm is a rare syndrome that can arise after correction of severe kyphosis. Symptoms include abdominal pain and ileus and liver dysfunctions. These symptoms can be easily attributed to more common causes like the superior mesenteric artery syndrome, and a delay in the diagnosis of celiac artery obstruction may result in severe ischemic disease of the gastrointestinal tract. We present a case of celiac artery syndrome after correction of a kyphoscoliosis with severe sequelae that has not been documented before...
January 2019: Spine Deformity
David P Burns, Kevin H Murphy, Eric F Lucking, Ken D O'Halloran
KEY POINTS: Respiratory muscle weakness is a major feature of Duchenne muscular dystrophy (DMD), yet little is known about the neural control of the respiratory muscles in DMD and animal models of dystrophic disease. Substantial diaphragm muscle weakness is apparent in young (8-week-old) mdx mice, but ventilatory capacity in response to maximum chemostimulation in conscious mice is preserved. Peak volume- and flow-related measures during chemoactivation are equivalent in anaesthetized, vagotomized wild-type and mdx mice...
December 20, 2018: Journal of Physiology
Abdallah Fayssoil, Cendrine Chaffaut, Adam Ogna, Tanya Stojkovic, Laure Lamothe, Dominique Mompoint, Paris Meng, Helene Prigent, Bernard Clair, Anthony Behin, Pascal Laforet, Guillaume Bassez, Robert Carlier, David Orlikowski, Helge Amthor, Susana Quijano Roy, Pascal Crenn, Sylvie Chevret, Bruno Eymard, Frederic Lofaso, Djillali Annane
BACKGROUND: Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic muscle disorder. Respiratory muscle function is classically affected in this disease. Ultrasound recently emerged as a non-invasive tool to assess diaphragm function. However, there are only a few studies using diaphragm ultrasound (US) in DMD. PURPOSE: We aimed to assess diaphragm ultrasound patterns in DMD, their relationship with age and their association with home mechanical ventilation (HMV)...
December 8, 2018: Journal of Neuromuscular Diseases
Miguel Goulão, Biswarup Ghosh, Mark W Urban, Malya Sahu, Christina Mercogliano, Brittany A Charsar, Sreeya Komaravolu, Cole G Block, George M Smith, Megan C Wright, Angelo C Lepore
Stem/progenitor cell transplantation delivery of astrocytes is a potentially powerful strategy for spinal cord injury (SCI). Axon extension into SCI lesions that occur spontaneously or in response to experimental manipulations is often observed along endogenous astrocyte "bridges," suggesting that augmenting this response via astrocyte lineage transplantation can enhance axon regrowth. Given the importance of respiratory dysfunction post-SCI, we transplanted glial-restricted precursors (GRPs)-a class of lineage-restricted astrocyte progenitors-into the C2 hemisection model and evaluated effects on diaphragm function and the growth response of descending rostral ventral respiratory group (rVRG) axons that innervate phrenic motor neurons (PhMNs)...
December 11, 2018: Glia
Tom Schepens, Martin Dres, Leo Heunks, Ewan C Goligher
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...
December 5, 2018: Current Opinion in Critical Care
J Ricoy, N Rodríguez-Núñez, J M Álvarez-Dobaño, M E Toubes, V Riveiro, L Valdés
The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests...
November 30, 2018: Pulmonology
Pia Sjöberg, Johannes Töger, Erik Hedström, Per Arvidsson, Einar Heiberg, Håkan Arheden, Ronny Gustafsson, Shahab Nozohoor, Marcus Carlsson
Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy of Fallot (rToF) to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and pulmonary regurgitation (PR) > 20% ( n = 18) and healthy control subjects ( n = 15) underwent MRI, including four-dimensional flow...
December 1, 2018: American Journal of Physiology. Heart and Circulatory Physiology
Pongdhep Theerawit, Dararat Eksombatchai, Yuda Sutherasan, Thitiporn Suwatanapongched, Charn Kiatboonsri, Sumalee Kiatboonsri
BACKGROUND: Diaphragmatic dysfunction remains the main cause of weaning difficulty or failure. Ultrasonographic measurement of diaphragmatic function can be used to predict the outcomes of weaning from mechanical ventilation. Our primary objective was to investigate the performance of various sonographic parameters of diaphragmatic function for predicting the success of weaning from mechanical ventilation. METHODS: We prospectively enrolled 68 adult patients requiring mechanical ventilation who were admitted to the intensive care unit from June 2013 to November 2013...
November 23, 2018: BMC Pulmonary Medicine
Ewan C Goligher, Laurent J Brochard, W Darlene Reid, Eddy Fan, Olli Saarela, Arthur S Slutsky, Brian P Kavanagh, Gordon D Rubenfeld, Niall D Ferguson
Several mechanisms of diaphragm muscle injury (myotrauma) can result in ventilator-induced diaphragm dysfunction, including ventilator over-assistance, under-assistance, eccentric contractions, and end-expiratory shortening. In this Personal View, we summarise the evidence for the clinical relevance of these mechanisms, and present new data based on mediation analysis supporting the hypothesis that myotrauma due to ventilator over-assistance and under-assistance contribute, in part, to the effect of mechanical ventilation on clinical outcomes...
November 16, 2018: Lancet Respiratory Medicine
Yung-Yang Liu, Li-Fu Li
Mechanical ventilation (MV) is life-saving for patients with acute respiratory failure but also causes difficult liberation of patients from ventilator due to rapid decrease of diaphragm muscle endurance and strength, which is termed ventilator-induced diaphragmatic damage (VIDD). Numerous studies have revealed that VIDD could increase extubation failure, ICU stay, ICU mortality, and healthcare expenditures. However, the mechanisms of VIDD, potentially involving a multistep process including muscle atrophy, oxidative loads, structural damage, and muscle fiber remodeling, are not fully elucidated...
November 19, 2018: Experimental Biology and Medicine
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