TY - JOUR T1 - Ventilator-induced diaphragm dysfunction: time for (contr)action! JF - European Respiratory Journal JO - Eur Respir J SP - 12 LP - 15 DO - 10.1183/09031936.00076513 VL - 42 IS - 1 AU - Ghislaine Gayan-Ramirez Y1 - 2013/07/01 UR - http://erj.ersjournals.com/content/42/1/12.abstract N2 - During the past 10 years, intensive experimental research has focused on the effects of mechanical ventilation on the diaphragm. Whatever the animal species studied, all these studies have consistently shown that mechanical ventilation impaired diaphragm function, resulting in the so-called ventilator-induced diaphragm dysfunction (VIDD) [1–9]. The development of this effect is rapid and worsens with the time spent on the ventilator [5]. It is associated with early diaphragm fibre atrophy leading, ultimately, to diaphragm weight loss and to diaphragm ultrastructural alterations, with disorganisation of the sarcomere's architecture [8]. Oxidative stress, decreased protein synthesis and increased proteolysis have been all reported in the diaphragm after mechanical ventilation [8]. These data revealed that a healthy diaphragm was made diseased after mechanical ventilation. For a long time, the importance of these data has been neglected, probably because of the experimental nature of the studies. But the study of Levine et al. [10] in ventilated brain-dead organ donors, which revealed rapid diaphragm fibre atrophy and enhanced proteolysis, as in animal models, highlighted the fact that the mechanical ventilation effect was not exclusive to laboratory models. Subsequent studies in animal models, and also in humans, have further documented the impact of controlled mechanical ventilation on the diaphragm [11–20]. Despite this evidence, the impact of VIDD as an important component of diaphragm disability during mechanical ventilation remains questioned. It has been claimed that the available data pertain to controlled mechanical ventilation, a ventilation mode which is not the preferential mode of ventilation in patients. Well, this is true, although this ventilation mode is a necessary tool in particular situations (e.g. in patients treated with neuromuscular blocking agents, in attempts to minimise oxygen consumption, and in patients with central … ER -