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Review

Bench-to-bedside review: Diaphragm muscle function in disuse and acute high-dose corticosteroid treatment

Catherine SH Sassoon12* and Vincent J Caiozzo3

Author Affiliations

1 Department of Medicine, University of California, Irvine, California, USA

2 Department of Medicine, Pulmonary and Critical Care Section, VA Long Beach Healthcare System (11/111P), 5901 East 7th Street, Long Beach, CA 90822, USA

3 Department of Orthopedic Surgery, Physiology and Biophysics, University of California, Irvine, California, USA

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Critical Care 2009, 13:221  doi:10.1186/cc7971

Published: 8 September 2009

Abstract

Critically ill patients may require mechanical ventilatory support and short-term high-dose corticosteroid to treat some specific underlying disease processes. Diaphragm muscle inactivity induced by controlled mechanical ventilation produces dramatic alterations in diaphragm muscle structure and significant losses in function. Although the exact mechanisms responsible for losses in diaphragm muscle function are still unknown, recent studies have highlighted the importance of proteolysis and oxidative stress. In experimental animals, short-term strategies that maintain partial diaphragm muscle neuromechanical activation mitigate diaphragmatic force loss. In animal models, studies on the influence of combined controlled mechanical ventilation and short-term high-dose methylprednisolone have given inconsistent results in regard to the effects on diaphragm muscle function. In the critically ill patient, further research is needed to establish the prevalence and mechanisms of ventilator-induced diaphragm muscle dysfunction, and the possible interaction between mechanical ventilation and the administration of high-dose corticosteroid. Until then, in caring for these patients, it is imperative to allow partial activation of the diaphragm, and to administer the lowest dose of corticosteroid for the shortest duration possible.