UMEM Educational Pearls

Category: Critical Care

Title: Diaphragm weakness and its significance

Keywords: diaphragm weakness, respiratory failure (PubMed Search)

Posted: 1/13/2015 by Feras Khan, MD
Click here to contact Feras Khan, MD

Diaphragm weakness and its significance

  • Acute respiratory failure is partially due to respiratory muscles inability to meet the demands of respiration that is strained by a medical condition
  • Ventilation can have an adverse effect on respiratory muscles even after just 5-6 days (atrophy)

There are several ways to monitor diaphragm strength and function

  • Airway pressure and flow waveforms
  • Occlusion pressure
  • Esophageal pressure waveforms
  • Sniff maneuvers
  • Ultrasound
  • Diaphragm EMG
  • Chest xray

Clinical Relevance

  • Goal is to use these devices to limit the development of respiratory muscle atrophy because of disuse
  • Prevent "overassist" from the ventilator
  • Potential use in weaning trials to evaluate for respiratory muscle performance
  • This is a new area of intensive care research that could lead to improvements in outcomes


Curr Opin Crit Care. 2015 Feb;21(1):34-41. doi: 10.1097/MCC.0000000000000168.

Monitoring and preventing diaphragm injury.

Heunks LM1, Doorduin J, van der Hoeven JG.