Positive End-Expiratory Pressure Ventilation Induces Longitudinal Atrophy in Diaphragm Fibers.
Johan LindqvistMarloes van den BergRobbert van der PijlPleuni E HooijmanAlbertus BeishuizenJudith ElshofMonique de WaardArmand GirbesAngelique Spoelstra-de ManZhong-Hua ShiCharissa van den BromSylvia BogaardsShengyi ShenJoshua StromHenk GranzierJeroen KoleRené J P MustersMarinus A PaulLeo M A HeunksCoen A C OttenheijmPublished in: American journal of respiratory and critical care medicine (2019)
Mechanical ventilation with PEEP results in longitudinal atrophy of diaphragm fibers, a response that is modulated by the elasticity of the giant sarcomeric protein titin. We postulate that longitudinal atrophy, in concert with the aforementioned cross-sectional atrophy, hampers spontaneous breathing trials in critically ill patients: during these efforts, end-expiratory lung volume is reduced, and the shortened diaphragm fibers are stretched to excessive sarcomere lengths. At these lengths, muscle fibers generate less force, and diaphragm weakness ensues.