Ventilator-induced diaphragm dysfunction: time for (contr)action!

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 ventilatorinduced 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.