Diaphragmatic dysfunction

Mikawa, K., Kodama, S. I., Nishina, K., Obara, H., ONO-1714, a new inducible nitric oxide synthase inhibitor, attenuates diaphragmatic dysfunction associated with cerulein-induced pancreatitis in rats, Crit. Care Med. 29 (2001),... 

Upper airway obstruction Epiglottitis and laryngitis Cricoar5ftenoid arthritis Bronchiectasis Bronchiolitis obliterans Shrinking lung syndrome Diaphragmatic dysfunction Pulmonary vascular disease Thromboembolic disease Pulmonary arterial hypertension Mediastinal and axillary lymphadenopathy... 

Teixeira A, Cherin P, Demoule A, et al. Diaphragmatic dysfunction in patients with idiopathic inflammatory myopathies. Neuromuscul Disord 2005 15(l) 32-39. 

During interactive modes, insufficient unloading from either inadequate support levels or from dys-synchronous flow can produce or perpetuate muscle dysfunction, from imposed loading (35-38). Mechanical ventilation can also produce muscle dysfunction if only controlled ventilation is used for prolonged periods. This ventilator-induced diaphragmatic dysfunction is akin to muscle atrophy in other skeletal muscles (33,34). 

Vassilakopoulos D, Petrof B. Ventilator induced diaphragmatic dysfunction. Am J Respir Crit Care Med 2004 169 336-341. 

Gay PC, Edmonds LC. Severe hypercapnia after low-flow oxygen therapy in patients with neuromuscular disease and diaphragmatic dysfunction. Mayo Clin Proc 1995 70 327-330. Mannino D. Chronic obstructive pulmonary disease in 2025 where are we headed Eur Respir J 2005 26 189. 

Skeletal muscle dysfunction can cause myalgia, bone pain, weakness, and potentially fatal rhabdomyolysis. Respiratory muscle weakness and diaphragmatic contractile dysfunction can cause acute respiratory failure. 

The gastroesophageal junction is a complex sphincter composed of both a diaphragmatic element and the smooth muscle LES. This anatomically and physiologically complex organ is vulnerable to dysfunction by several mechanisms. Mechanically, the gastroesophageal junction must protect against reflux in both static and dynamic conditions. Failure to adequately prevent reflux is associated with both the initiation of GERD and relapse and chronicity of the disease. 

The osteopathic structural examination was remarkable for severe exhalation restrictions of ribs three to ten with rigid intercostal muscles bilaterally. In addition, there was markedly decreased diaphragmatic, thoracic inlet/outlet, sternal, and clavicular motion. Somatic dysfunctions included OAESrRi, C2ESrRr, and T2-T6NSiRr with increased tonicity of the intrascapular paravertebral muscles. 

The patient was treated for her somatic dysfunctions on the first visit with a combination of techniques including, muscle energy, facilitated positional release, high-velocity low-amplitude (HVLA), and cranial osteopathy. In addition, ventral visceral techniques were used. The left hemi-diaphragm was discovered to be restricted as well and a diaphragmatic release was used. Begiiming in the left lower quadrant, the physician scooped the abdomen toward the umbilicus and held until the structures released. This was directed at supporting the mesentery and the sig-... 

In laboratory animals, controlled mechanical ventilation delivered for 1 to 11 days can decrease diaphragmatic force generation by 20-50% and can cause similar decreases in diaphragmatic endurance (40). Several mechanisms, including stmctural injury, muscle atrophy, and oxidative stress, appear to be responsible for ventilator-associated respiratory muscle dysfunction (40). Of interest, in a study of more than 200 critically ill patients— 80% of whom required acute ventilator support—duration of mechanical ventilation was nearly three days shorter in those who completed a 10-day antioxidant supplementation protocol (vitamins E and C) than in those who completed a 10-day course of placebo (76). 

Whether ventilator-associated respiratory muscle dysfunction occurs in humans is unclear. In 13 infants who received uninterrupted ventilator assistance for at least 12 days before death, most diaphragmatic fibers appeared atrophic (Fig. 9) (77). These data are supported by a recent preliminary report of Levine et al. (78) who compared costal diaphragm biopsies of six brain-dead organ donors maintained on controlled mechanical ventilation for... 

Less frequently, local infections, scar tissue, or fluid around the receiver can impair pacing effectiveness. If receiver migration has occurred or if the internal components require repair or replacement, then surgical exploration may be required. Dysfunctional phrenic nerve conduction or diaphragmatic responses are sometimes reversible. 

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