Abstract

TORO CONTRERAS, Celina Del. Mechanical ventilation for lung and diaphragm protection in intensive care. Med. crít. (Col. Mex. Med. Crít.) [online]. 2023, vol.37, n.2, pp.122-133.  Epub May 13, 2024. ISSN 2448-8909.  https://doi.org/10.35366/110448.

Critically ill patients with mechanical ventilation present multiple deleterious changes in the structure and function of the diaphragm, collectively called ventilator-induced diaphragmatic dysfunction. There are four possible mechanisms of diaphragmatic myotrauma: ventilatory over-assistance, low ventilatory assistance, eccentric myotrauma and expiratory myotrauma; underlying molecular and cellular processes include metabolic dysfunction, mitochondrial oxidative stress, and imbalance in protein homeostasis culminating in diaphragmatic atrophy. The growing understanding of the mechanisms of diaphragmatic myotrauma, ventilator-induced pulmonary injury and self-inflicted pulmonary injury gives rise to a mechanical ventilation approach in intensive care that integrates pulmonary and diaphragmatic protection measures: Respiratory drive, respiratory effort, transpulmonary pressure, intraabdominal pressure , positive end-expiratory pressure, management of asynchronies, oxygenation and analgesia-sedation, in addition to considering the medical treatment of concurrent conditions, with the aim of favoring the release of MV, preventing long-term disability and increasing the survival, as well as encourage future research for implementation in the clinical setting.

Keywords : diaphragm; myotrauma; mechanical ventilation; atrophy; drive.