jueves, 5 de mayo de 2016

Disfunción de músculos respiratorios en UCI / Dysfunction of respiratory muscles in ICUs

Mayo 4, 2016. No. 2316



 Disfunción de los músculos respiratorios en pacientes graves de la terapia intensiva
Dysfunction of respiratory muscles in critically ill patients on the intensive care unit.
J Cachexia Sarcopenia Muscle. 2016 Mar 9. doi: 10.1002/jcsm.12108. [Epub ahead of print]
Abstract
Muscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed 'ventilator-induced diaphragmatic dysfunction' (VIDD) and should be distinguished from peripheral muscular weakness as observed in 'ICU-acquired weakness (ICU-AW)'. Interestingly, VIDD and ICU-AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross-sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues.
KEYWORDS: Cachexia; Diaphragm; ICU-acquired weakness; Mechanical ventilation; Sepsis; VIDD; Weakness; weaning failure
Committee for European Education in Anaesthesiology (CEEA)
Colegio de Anestesiólogos de León AC
MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor.
Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.  
En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016.
Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com
VIII Foro Internacional de Medicina del Dolor y Paliativa 
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Junio 9-11, Ciudad de México
Dra. Argelia Lara Solares
Tel. 5513 3782  www.dolorypaliativos.org 
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