Debate on the Role of Eccentric Contraction of the Diaphragm: Is It Always Harmful?

TL;DR

This paper reviews whether harmful diaphragm contractions during mechanical ventilation can be avoided by adjusting ventilation settings properly.

Contribution

The paper provides a clinical perspective on preventing diaphragm injury through optimized ventilation programming.

Findings

Improper ventilation settings can cause diaphragm deterioration linked to higher mortality.

Eccentric contractions of the diaphragm during ventilation are associated with muscle injury.

Adjusting ventilation variables appropriately may prevent myotrauma and improve outcomes.

Abstract

The diaphragm is the primary muscle involved in the ventilatory pump, making it a vital component in mechanical ventilation. Various factors in patients who require mechanical ventilation can lead to the deterioration of the diaphragm, which is associated with increased mortality. This deterioration can arise from either excessive or insufficient support due to improper adjustment of ventilation programming variables. It is essential for healthcare professionals to make appropriate adjustments to these variables to prevent myotrauma, which negatively impacts muscle structure and function. One recognized cause of muscle injury is eccentric work of the diaphragm, which occurs when muscle contractions continue after the expiratory valve has opened. Current evidence suggests that these eccentric contractions during mechanical ventilation can be harmful. This brief review highlights and analyzes the existing evidence and offers our clinical perspective on the importance of properly adjusting ventilation programming variables, as well as the potential negative effects of eccentric diaphragm contractions in routine clinical practice.

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