Etiology and pathogenesis of ventilator-induced diaphragm dysfunction
The diaphragm is one of the most important respiratory muscles in the human body,of which 60%-80%of the function of the respiratory muscle is played by the diaphragm.Mechanical ventilation is a common respiratory support method for severely ill patients in clinical.However,improper use of the ventilator can also lead to ventilator-induced diaphragm dysfunction(VIDD)while maintaining patients'respiratory function.The pathogenesis of VIDD is mainly induced by mechanical ventilation leading to diaphragmatic mitochondrial oxidative stress(MOS).In addition,the protein degradation of the ubiquitin-proteasome system(UPS),autophagy,changes in calpain activity,calcium,and cytokines also play important roles in the process of VIDD.In-depth understanding the pathological mechanism of VIDD is beneficial to prevent and treat VIDD.This article reviews the research progress of the potential etiology(improper use of ventilator,age,nutritional and metabolic status,coronary disease,drug factors)and pathogenesis(mitochondrial oxidative stress,autophagy of diaphragm cells,activation of calpain,and increase of intracellular calcium)of VIDD,so as to provide reference for the treatment of VIDD.
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