• Gerald S Supinski, Peter E Morris, Sanjay Dhar, and Callahan Leigh Ann LA Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY. Electronic address: lacall2@email.uky.edu..
• Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY.
• Chest. 2018 Apr 1; 153 (4): 1040-1051.

AbstractThe diaphragm is the major muscle of inspiration, and its function is critical for optimal respiration. Diaphragmatic failure has long been recognized as a major contributor to death in a variety of systemic neuromuscular disorders. More recently, it is increasingly apparent that diaphragm dysfunction is present in a high percentage of critically ill patients and is associated with increased morbidity and mortality. In these patients, diaphragm weakness is thought to develop from disuse secondary to ventilator-induced diaphragm inactivity and as a consequence of the effects of systemic inflammation, including sepsis. This form of critical illness-acquired diaphragm dysfunction impairs the ability of the respiratory pump to compensate for an increased respiratory workload due to lung injury and fluid overload, leading to sustained respiratory failure and death. This review examines the presentation, causes, consequences, diagnosis, and treatment of disorders that result in acquired diaphragm dysfunction during critical illness.Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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