In 1988, Knisely et al. “noted marked thinning of the muscular portions of the diaphragm” in neonates following prolonged mechanical ventilation [
1]. This provided the first evidence that adverse patient–ventilator interactions can cause deleterious structural changes in the diaphragm, a phenomenon recently termed myotrauma [
2]. Extensive experimental and clinical investigation has confirmed the existence of myotrauma and characterized its prevalence and clinical impact [
3]. Diaphragm myotrauma is a serious concern because it leads to acute diaphragm weakness (referred to as ventilator-induced diaphragm dysfunction; see Table
1 for terminology) and can therefore impair patients’ ability to be liberated from mechanical ventilation. Prolonged mechanical ventilation predisposes patients to nosocomial complications and strongly predicts long-term morbidity and mortality [
4]. Preventing myotrauma might therefore accelerate liberation from mechanical ventilation and significantly improve...
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The author thanks Thomas Piraino, RRT, and Laurent Brochard, MD, for helpful suggestions on this manuscript.
Compliance with ethical standards
Conflicts of interest
Dr. Goligher’s laboratory has received non-financial support in the form of equipment from Getinge and GE. Dr. Goligher reports receiving speaking honoraria from Getinge.
An approval by an ethics committee was not applicable.
Knisely AS, Leal SM, Singer DB (1988) Abnormalities of diaphragmatic muscle in neonates with ventilated lungs. J Pediatr 113:1074–1077CrossRefGoogle Scholar