Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation perspective

Respir Physiol Neurobiol. 2013 Nov 1;189(2):377-83. doi: 10.1016/j.resp.2013.05.012. Epub 2013 May 18.


Most patients are easily liberated from mechanical ventilation (MV) following resolution of respiratory failure and a successful trial of spontaneous breathing, but about 25% of patients experience difficult weaning. MV use leads to cellular changes and weakness, which has been linked to weaning difficulties and has been labeled ventilator induced diaphragm dysfunction (VIDD). Aggravating factors in human studies with prolonged weaning include malnutrition, chronic electrolyte abnormalities, hyperglycemia, excessive resistive and elastic loads, corticosteroids, muscle relaxant exposure, sepsis and compromised cardiac function. Numerous animal studies have investigated the effects of MV on diaphragm function. Virtually all these studies have concluded that MV use rapidly leads to VIDD and have identified cellular and molecular mechanisms of VIDD. Molecular and functional studies on the effects of MV on the human diaphragm have largely confirmed the animal results and identified potential treatment strategies. Only recently potential VIDD treatments have been tested in humans, including pharmacologic interventions and diaphragm "training". A limited number of human studies have found that specific diaphragm training can increase respiratory muscle strength in FTW patients and facilitate weaning, but larger, multicenter trials are needed.

Keywords: Diaphragm strength training; Ventilator induced diaphragm dysfunction; Ventilator weaning.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Diaphragm / physiology*
  • Diaphragm / physiopathology
  • Humans
  • Muscle Strength / physiology
  • Muscle Weakness / diagnosis
  • Muscle Weakness / physiopathology*
  • Muscle Weakness / rehabilitation*
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods*
  • Respiratory Muscles / physiology
  • Respiratory Muscles / physiopathology
  • Ventilator Weaning / adverse effects
  • Ventilator Weaning / methods*