Patients with impending respiratory failure often require mechanical ventilation (MV) to optimize gas exchange. Although this form of assisted ventilation is required for survival, its persistent use results in diaphragm weakness and muscle fiber atrophy. There is strong evidence that MV alters the structure and function of the diaphragm, resulting in prolonged dependence on assisted ventilation and long-term consequences such as a delayed functional recovery, reduced quality of life, and increased risk of mortality. This review summarizes the mechanisms underlying diaphragm dysfunction due to prolonged MV, highlights the role of inspiratory muscle exercise as a strategy to counter diaphragm weakness, and identifies the parameters of an evidence-supported exercise prescription for difficult to wean patients.
Departments of 1Physical Therapy
2Pediatrics, University of Florida, Gainesville, FL
Correspondence: Barbara Smith, PhD, PT, P.O. Box 100154, Department of Physical Therapy, University of Florida Gainesville, FL 32610-0154 (firstname.lastname@example.org).
R01 AR072328 to A. D. Martin and R21 HD090752 to B. K. Smith.
A. D. Martin is an external consultant for Lungpacer, which is developing an intravenous phrenic nerve pacing system.
Each author has contributed substantially to the structure and composition of this manuscript, and we acknowledge responsibility for its contents.
This review paper does not require Institutional Review Board approval.