CAN WE REVERSE NEGATIVE IMPACT OF PROLONGED MECHANICAL VENTILATION ON RESPIRATORY MUSCLES?

BACKGROUND: Prolonged mechanical ventilation although saving lives, can have decremental eff ect on repiratory muscles, mainly diaphragm. Th e aim of this article is to summarize the mechanisms of respiratory muscle atrophy and possible interventions for atrophy reversal.Discussion Systematic literature review. CONCLUSIONS: Intensive care unit physicians are aware of negative impact of nechanical ventilation on lung parenchyma. But recently more and more evidence is accumulating, that mechanical ventilation provides isuffi cient stress on respiratory muscles and with that promoting diaphragm atrophy and contractile dysfunction which leads to prolonged weaning and ventilator dependency. Research on animals has documented that inactivity of diaphragm induces injury and atrophy of muscle cells. Studies on patients on controlled mechanical mentilation confi rmed this phenomena in humans. Th e mechanisms of diaphragm atrophy are complex an include oxidative injury, decreased protein turnover, gene expresson and cell signaling, and induction of diaphragm muscle cell apoptosis. Diaphragm atrophy and dysfunction leads to prolonged mechanical ventilation, ventilator dependency and also to increased mortality. Th is phenomena can be in some patients reversed with respiratory muscle training. Th e results between studies vary, mainly beacuse in they used diff erent methods of respiratory muscle training, and included the patients with diff erent diseases. Future studies will show which patients will have the greatest benefi t from respiratory muscle trainig and which trainig regime is best for muscle growth induction