51
|
Increased SOD2 in the diaphragm contributes to exercise-induced protection against ventilator-induced diaphragm dysfunction. Redox Biol 2018; 20:402-413. [PMID: 30414534 PMCID: PMC6226598 DOI: 10.1016/j.redox.2018.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/22/2023] Open
Abstract
Mechanical ventilation (MV) is a life-saving intervention for many critically ill patients. Unfortunately, prolonged MV results in rapid diaphragmatic atrophy and contractile dysfunction, collectively termed ventilator-induced diaphragm dysfunction (VIDD). Recent evidence reveals that endurance exercise training, performed prior to MV, protects the diaphragm against VIDD. While the mechanism(s) responsible for this exercise-induced protection against VIDD remain unknown, increased diaphragm antioxidant expression may be required. To investigate the role that increased antioxidants play in this protection, we tested the hypothesis that elevated levels of the mitochondrial antioxidant enzyme superoxide dismutase 2 (SOD2) is required to achieve exercise-induced protection against VIDD. Cause and effect was investigated in two ways. First, we prevented the exercise-induced increase in diaphragmatic SOD2 via delivery of an antisense oligonucleotide targeted against SOD2 post-exercise. Second, using transgene overexpression of SOD2, we determined the effects of increased SOD2 in the diaphragm independent of exercise training. Results from these experiments revealed that prevention of the exercise-induced increases in diaphragmatic SOD2 results in a loss of exercise-mediated protection against MV-induced diaphragm atrophy and a partial loss of protection against MV-induced diaphragmatic contractile dysfunction. In contrast, transgenic overexpression of SOD2 in the diaphragm, independent of exercise, did not protect against MV-induced diaphragmatic atrophy and provided only partial protection against MV-induced diaphragmatic contractile dysfunction. Collectively, these results demonstrate that increased diaphragmatic levels of SOD2 are essential to achieve the full benefit of exercise-induced protection against VIDD. Prolonged mechanical ventilation results in diaphragmatic weakness which is labeled as ventilator-induced diaphragm dysfunction (VIDD). Endurance exercise training performed prior to mechanical ventilation protects the diaphragm against VIDD. Preventing exercise-induced increases of superoxide dismutase 2 (SOD2) in the diaphragm partially abolishes exercise protection against VIDD. Transgenic overexpression of SOD2 in the diaphragm provides only partial protection against VIDD. We conclude that increases in SOD2 abundance in the diaphragm contributes to the exercise-induced protection against VIDD.
Collapse
|
52
|
Le Dinh M, Carreira S, Obert J, Gayan-Ramirez G, Riou B, Beuvin M, Similowski T, Coirault C, Demoule A. Prolonged mechanical ventilation worsens sepsis-induced diaphragmatic dysfunction in the rat. PLoS One 2018; 13:e0200429. [PMID: 30067847 PMCID: PMC6070213 DOI: 10.1371/journal.pone.0200429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/26/2018] [Indexed: 12/17/2022] Open
Abstract
Background Short-term mechanical ventilation (MV) protects against sepsis-induced diaphragmatic dysfunction. Prolonged MV induces diaphragmatic dysfunction in non-septic animals, but few reports describe the effects of prolonged MV in sepsis. We hypothesized that prolonged MV is not protective but worsens the diaphragmatic dysfunction induced by a mild sepsis, because MV and sepsis share key signaling mechanisms, such as cytokine upregulation. Method We studied the impact of prolonged MV (12 h) in four groups (n = 8) of male Wistar rats: 1) endotoxemia induced by intraperitoneal injection of Escherichia coli lipopolysaccharide, 2) MV without endotoxemia, 3) combination of endotoxemia and MV and 4) sham control. Diaphragm mechanical performance, pro-inflammatory cytokine concentrations (Tumor Necrosis Factor-α, Interleukin-1β, Interleukin-6) in plasma were measured. Results Prolonged MV and sepsis independtly reduced maximum diaphragm force (-27%, P = 0.003; -37%, P<0.001; respectively). MV and sepsis acted additively to further decrease diaphragm force (-62%, P<0.001). Similar results were observed for diaphragm kinetics (maximum lengthening velocity -47%, P<0.001). Sepsis and MV reduced diaphragm cross sectional area of type I and IIx fibers, which was further increased by the combination of sepsis and MV (all P<0.05). Sepsis and MV were individually associated with the presence of a robust perimysial inflammatory infiltrate, which was more marked when sepsis and MV were both present (all P<0.05). Sepsis and, to a lesser extent, MV increased proinflammatory cytokine production in plasma and diaphragm (all P<0.05); proinflammatory cytokine expression in plasma was increased further by the combination of sepsis and MV (all P<0.05). Maximum diaphragm force correlated negatively with plasma and diaphragmatic cytokine production (all p<0.05). Conclusions Prolonged (12 h) MV exacerbated sepsis-induced decrease in diaphragm performance. Systemic and diaphragmatic overproduction of pro-inflammatory cytokines may contribute to diaphragm weakness.
Collapse
Grants
- Alexandre Demoule reports personal fees from Maquet, grants, personal fees and non-financial support from Covidien, personal fees from MSD, grants and non-financial support from Philips, non-financial support from Drager, grants and personal fees from Resmed, personal fees from fisher & Paykel, all outside the submitted work. The funder provided support in the form of salaries for AD, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of this author is articulated in the ‘author contributions’ section.
- Chancellerie des Universités de Paris
- Institut Fédératif de Recherche 14-INSERM
- APHP
- Société de Réanimation de Langue Française (FR)
- CARDIF – L’Assistance Respiratoire
Collapse
Affiliation(s)
- Matthieu Le Dinh
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 1158, Paris, France
| | - Serge Carreira
- Department of Anesthesiology and Critical Care Groupe hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 1166, IHU ICAN, Paris, France
| | - Julie Obert
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 974, Institut de Myologie, Paris, France
| | - Ghislaine Gayan-Ramirez
- Respiratory Muscle Research Unit, Laboratory of Pneumology and Respiratory Division, Katholieke Universiteit, Leuven, Belgium
| | - Bruno Riou
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 1166, IHU ICAN, Paris, France
- Department of Emergency Medicine and Surgery Groupe hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Maud Beuvin
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 974, Institut de Myologie, Paris, France
| | - Thomas Similowski
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 1158, Paris, France
- Department of Pneumology and Medical Intensive Care Groupe hospitalier Pitié-Salpêtrière, APHP, Paris France
| | - Catherine Coirault
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 974, Institut de Myologie, Paris, France
| | - Alexandre Demoule
- Sorbonnes Universités UPMC Univ Paris 06, UMRS INSERM 1158, Paris, France
- Department of Pneumology and Medical Intensive Care Groupe hospitalier Pitié-Salpêtrière, APHP, Paris France
- * E-mail:
| |
Collapse
|
53
|
Morton AB, Mor Huertas A, Hinkley JM, Ichinoseki-Sekine N, Christou DD, Smuder AJ. Mitochondrial accumulation of doxorubicin in cardiac and diaphragm muscle following exercise preconditioning. Mitochondrion 2018; 45:52-62. [PMID: 29474837 DOI: 10.1016/j.mito.2018.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/22/2017] [Accepted: 02/15/2018] [Indexed: 12/22/2022]
Abstract
Doxorubicin (DOX) is a highly effective anthracycline antibiotic. Unfortunately, the clinical use of DOX is limited by the risk of deleterious effects to cardiac and respiratory (i.e. diaphragm) muscle, resulting from mitochondrial reactive oxygen species (ROS) production. In this regard, exercise is demonstrated to protect against DOX-induced myotoxicity and prevent mitochondrial dysfunction. However, the protective mechanisms are currently unclear. We hypothesized that exercise may induce protection by increasing the expression of mitochondria-specific ATP-binding cassette (ABC) transporters and reducing mitochondrial DOX accumulation. Our results confirm this finding and demonstrate that two weeks of exercise preconditioning is sufficient to prevent cardiorespiratory dysfunction.
Collapse
Affiliation(s)
- Aaron B Morton
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Andres Mor Huertas
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - J Matthew Hinkley
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | | | - Demetra D Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Ashley J Smuder
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States.
| |
Collapse
|
54
|
Smuder AJ, Sollanek KJ, Nelson WB, Min K, Talbert EE, Kavazis AN, Hudson MB, Sandri M, Szeto HH, Powers SK. Crosstalk between autophagy and oxidative stress regulates proteolysis in the diaphragm during mechanical ventilation. Free Radic Biol Med 2018; 115:179-190. [PMID: 29197632 PMCID: PMC5767544 DOI: 10.1016/j.freeradbiomed.2017.11.025] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/25/2022]
Abstract
Mechanical ventilation (MV) results in the rapid development of ventilator-induced diaphragm dysfunction (VIDD). While the mechanisms responsible for VIDD are not fully understood, recent data reveal that prolonged MV activates autophagy in the diaphragm, which may occur as a result of increased cellular reactive oxygen species (ROS) production. Therefore, we tested the hypothesis that (1) accelerated autophagy is a key contributor to VIDD; and that (2) oxidative stress is required to increase the expression of autophagy genes in the diaphragm. Our findings reveal that targeted inhibition of autophagy in the rat diaphragm prevented MV-induced muscle atrophy and contractile dysfunction. Attenuation of VIDD in these animals occurred as a result of increased diaphragm concentration of the antioxidant catalase and reduced mitochondrial ROS emission, which corresponded to reductions in the activity of calpain and caspase-3. To determine if increased ROS production is required for the upregulation of autophagy biomarkers in the diaphragm, rats that were administered the mitochondrial-targeted peptide SS-31 during MV. Results from this study demonstrated that mitochondrial ROS production in the diaphragm during MV is required for the increased expression of key autophagy genes (i.e. LC3, Atg7, Atg12, Beclin1 and p62), as well as for increased activity of cathepsin L. Together, these data reveal that autophagy is required for VIDD, and that autophagy inhibition reduces MV-induced diaphragm ROS production and prevents a positive feedback loop whereby increased autophagy is stimulated by oxidative stress, resulting in further increases in ROS and autophagy.
Collapse
Affiliation(s)
- Ashley J Smuder
- Department of Exercise Science, University of South Carolina, Room 227, 921 Assembly St, Columbia, SC 29208, United States.
| | - Kurt J Sollanek
- Department of Kinesiology, Sonoma State University, Rohnert Park, CA 94928, United States
| | - W Bradley Nelson
- Department of Natural Sciences, Ohio Dominican University, Columbus, OH 43219, United States
| | - Kisuk Min
- Department of Pharmacology, Yale University, New Haven, CT 06520, United States
| | - Erin E Talbert
- Department of Molecular Virology, Immunology and Medical Genetics, Ohio State University, Columbus, OH 43210, United States
| | - Andreas N Kavazis
- School of Kinesiology, Auburn University, Auburn, AL 36849, United States
| | - Matthew B Hudson
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, United States
| | - Marco Sandri
- Department of Biomedical Science, University of Padova, Padova, Italy
| | - Hazel H Szeto
- Department of Pharmacology, Weill Cornell Medical College, New York, NY 10021, United States
| | - Scott K Powers
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, United States
| |
Collapse
|
55
|
Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Vorona S, Sklar MC, Rittayamai N, Lanys A, Murray A, Brace D, Urrea C, Reid WD, Tomlinson G, Slutsky AS, Kavanagh BP, Brochard LJ, Ferguson ND. Mechanical Ventilation–induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. Am J Respir Crit Care Med 2018; 197:204-213. [DOI: 10.1164/rccm.201703-0536oc] [Citation(s) in RCA: 298] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ewan C. Goligher
- Interdepartmental Division of Critical Care Medicine
- Department of Physiology
- Department of Medicine
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Martin Dres
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Respiratory and Critical Care Department, Groupe Hospitalier Pitié Salpêtrière Charles Foix, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Gordon D. Rubenfeld
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Canada
| | - Damon C. Scales
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Canada
| | - Margaret S. Herridge
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
- Toronto General Research Institute, Toronto, Canada; and
| | - Stefannie Vorona
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Michael C. Sklar
- Department of Anesthesia, and
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Nuttapol Rittayamai
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Ashley Lanys
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Alistair Murray
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Deborah Brace
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Cristian Urrea
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - W. Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - George Tomlinson
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Arthur S. Slutsky
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Brian P. Kavanagh
- Interdepartmental Division of Critical Care Medicine
- Department of Physiology
- Department of Anesthesia, and
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada
| | - Laurent J. Brochard
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Niall D. Ferguson
- Interdepartmental Division of Critical Care Medicine
- Department of Physiology
- Department of Medicine
- Institute for Health Policy, Management, and Evaluation
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
56
|
Clinical Pearls in Venovenous Extracorporeal Life Support for Adult Respiratory Failure. ASAIO J 2018; 64:1-9. [DOI: 10.1097/mat.0000000000000657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
57
|
Vassilakopoulos T, Petrof BJ. A Stimulating Approach to Ventilator-induced Diaphragmatic Dysfunction. Am J Respir Crit Care Med 2017; 169:336-41. [PMID: 14739134 DOI: 10.1164/rccm.200304-489cp] [Citation(s) in RCA: 288] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
58
|
Samanta S, Singh RK, Baronia AK, Poddar B, Azim A, Gurjar M. Diaphragm thickening fraction to predict weaning-a prospective exploratory study. J Intensive Care 2017; 5:62. [PMID: 29158899 PMCID: PMC5683442 DOI: 10.1186/s40560-017-0258-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Diaphragm ultrasound (DUS) is a well-established point of care modality for assessment of dimensional and functional aspects of the diaphragm. Amongst various measures, diaphragmatic thickening fraction (DTf) is more comprehensive. However, there is still uncertainty about its capability to predict weaning from mechanical ventilation (MV). The present prospective observational exploratory study assessed the diaphragm at variable negative pressure triggers (NPTs) with US to predict weaning in ICU patients. Methods Adult ICU patients about to receive their first T-piece were included in the study. Linear and curvilinear US probes were used to measure right side diaphragm characteristics first at pressure support ventilation (PSV) of 8 cmH2O with positive end expiratory pressure (PEEP) of 5 cmH2O against NPTs of 2, 4, and 6 cmH2O and then later during their first T-piece. The measured variables were then categorized into simple weaning (SW) and complicated weaning (CW) groups and their outcomes analyzed. Results Sixty-four (M:F, 40:24) medical (55/64, 86%) patients were included in the study. Sepsis of lung origin (65.5%) was the dominant reason for MV. There were 33 and 31 patients in the SW and CW groups, respectively. DTf predicts SW with a cutoff ≥ 25.5, 26.5, 25.5, and 24.5 for 2, 4, and 6 NPTs and T-piece, respectively, with ≥ 0.90 ROC AUC. At NPT of 2, DTf had the highest sensitivity of 97% and specificity of 81% [ROC AUC (CI), 0.91 (0.84–0.99); p < 0.001]. Conclusions DTf may successfully predict SW and also help identify patients ready to wean prior to a T-piece trial.
Collapse
Affiliation(s)
- Sujay Samanta
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh 226014 India
| | - Ratender Kumar Singh
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh 226014 India
| | - Arvind K Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh 226014 India
| | - Banani Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh 226014 India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh 226014 India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow, Uttar Pradesh 226014 India
| |
Collapse
|
59
|
Tang H, L Kennedy C, Lee M, Gao Y, Xia H, Olguin F, Fraga DA, Ayers K, Choi S, Kim M, Tehrani A, Sowb YA, Rando TA, Shrager JB. Smad3 initiates oxidative stress and proteolysis that underlies diaphragm dysfunction during mechanical ventilation. Sci Rep 2017; 7:14530. [PMID: 29109401 DOI: 10.1038/s41598-017-11978-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/23/2017] [Indexed: 01/08/2023] Open
Abstract
Prolonged use of mechanical ventilation (MV) leads to atrophy and dysfunction of the major inspiratory muscle, the diaphragm, contributing to ventilator dependence. Numerous studies have shown that proteolysis and oxidative stress are among the major effectors of ventilator-induced diaphragm muscle dysfunction (VIDD), but the upstream initiator(s) of this process remain to be elucidated. We report here that periodic diaphragm contraction via phrenic nerve stimulation (PNS) substantially reduces MV-induced proteolytic activity and oxidative stress in the diaphragm. We show that MV rapidly induces phosphorylation of Smad3, and PNS nearly completely prevents this effect. In cultured cells, overexpressed Smad3 is sufficient to induce oxidative stress and protein degradation, whereas inhibition of Smad3 activity suppresses these events. In rats subjected to MV, inhibition of Smad3 activity by SIS3 suppresses oxidative stress and protein degradation in the diaphragm and prevents the reduction in contractility that is induced by MV. Smad3's effect appears to link to STAT3 activity, which we previously identified as a regulator of VIDD. Inhibition of Smad3 suppresses STAT3 signaling both in vitro and in vivo. Thus, MV-induced diaphragm inactivity initiates catabolic changes via rapid activation of Smad3 signaling. An early intervention with PNS and/or pharmaceutical inhibition of Smad3 may prevent clinical VIDD.
Collapse
Affiliation(s)
- Huibin Tang
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Catherine L Kennedy
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Myung Lee
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Yang Gao
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Hui Xia
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Department of Thoracic-cardio Surgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Francesca Olguin
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Danielle A Fraga
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Kelsey Ayers
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sehoon Choi
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
| | - Michael Kim
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Amir Tehrani
- Respiratory Management Technologies, LLC., San Francisco, CA, USA
| | - Yasser A Sowb
- Respiratory Management Technologies, LLC., San Francisco, CA, USA
| | - Thomas A Rando
- VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Paul F. Glenn Laboratories for the Biology of Aging and Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA. .,VA Palo Alto Healthcare System, Palo Alto, CA, USA.
| |
Collapse
|
60
|
Pardo PS, Lopez MA, Mohamed JS, Boriek AM. Anisotropic mechanosensitive pathways in the diaphragm and their implications in muscular dystrophies. J Muscle Res Cell Motil 2017; 38:437-446. [PMID: 28986699 DOI: 10.1007/s10974-017-9483-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022]
Abstract
The diaphragm is the "respiratory pump;" the muscle that generates pressure to allow ventilation. Diaphragm muscles play a vital function and thus are subjected to continuous mechanical loading. One of its peculiarities is the ability to generate distinct mechanical and biochemical responses depending on the direction through which the mechanical forces applied to it. Contractile forces originated from its contractile components are transmitted to other structural components of its muscle fibers and the surrounding connective tissue. The anisotropic mechanical properties of the diaphragm are translated into biochemical signals that are directionally mechanosensitive by mechanisms that appear to be unique to this muscle. Here, we reviewed the current state of knowledge on the biochemical pathways regulated by mechanical signals emphasizing their anisotropic behavior in the normal diaphragm and analyzed how they are affected in muscular dystrophies.
Collapse
Affiliation(s)
- Patricia S Pardo
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Michael A Lopez
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Junaith S Mohamed
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.,Laboratory of Muscle Biology and Sarcopenia, Division of Exercise Physiology, Department of Human Performance, Center for Cardiovascular and Respiratory Sciences, West Virginia University, School of Medicine, Morgantown, WV, 26506, USA
| | - Aladin M Boriek
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
| |
Collapse
|
61
|
Critical illness-associated diaphragm weakness. Intensive Care Med 2017; 43:1441-1452. [DOI: 10.1007/s00134-017-4928-4] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/31/2017] [Indexed: 11/26/2022]
|
62
|
Supinski GS, Morris PE, Dhar S, Callahan LA. Diaphragm Dysfunction in Critical Illness. Chest 2017; 153:1040-1051. [PMID: 28887062 DOI: 10.1016/j.chest.2017.08.1157] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022] Open
Abstract
The diaphragm is the major muscle of inspiration, and its function is critical for optimal respiration. Diaphragmatic failure has long been recognized as a major contributor to death in a variety of systemic neuromuscular disorders. More recently, it is increasingly apparent that diaphragm dysfunction is present in a high percentage of critically ill patients and is associated with increased morbidity and mortality. In these patients, diaphragm weakness is thought to develop from disuse secondary to ventilator-induced diaphragm inactivity and as a consequence of the effects of systemic inflammation, including sepsis. This form of critical illness-acquired diaphragm dysfunction impairs the ability of the respiratory pump to compensate for an increased respiratory workload due to lung injury and fluid overload, leading to sustained respiratory failure and death. This review examines the presentation, causes, consequences, diagnosis, and treatment of disorders that result in acquired diaphragm dysfunction during critical illness.
Collapse
Affiliation(s)
- Gerald S Supinski
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Peter E Morris
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Sanjay Dhar
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Leigh Ann Callahan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY.
| |
Collapse
|
63
|
De Jong A, Carreira S, Na N, Carillion A, Jiang C, Beuvin M, Lacorte JM, Bonnefont-Rousselot D, Riou B, Coirault C. Diaphragmatic function is enhanced in fatty and diabetic fatty rats. PLoS One 2017; 12:e0174043. [PMID: 28328996 PMCID: PMC5362060 DOI: 10.1371/journal.pone.0174043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/02/2017] [Indexed: 11/24/2022] Open
Abstract
Background Obesity is associated with a decrease in mortality in the intensive care unit (ICU) (the "obesity paradox"). We hypothesized that obesity may paradoxically improve diaphragmatic function. Methods Diaphragm contractility was prospectively recorded in vitro in adult male Zucker lean (control), fatty, and diabetic fatty rats, at rest, after 12h mechanical ventilation and after fatigue. We analyzed diaphragm morphology, cytokines, and protein expression of the protein kinase signaling pathways. Results Diaphragm active-force (AF) was higher in fatty (96±7mN.mm-2,P = 0.02) but not in diabetic fatty rats (90±17mN.mm-2) when compared with controls (84±8mN.mm-2). Recovery from fatigue was improved in fatty and diabetic fatty groups compared with controls. Ventilator-induced diaphragmatic dysfunction was observed in each group, but AF remained higher in fatty (82±8mN.mm-2,P = 0.03) compared with controls (70±8mN.mm-2). There was neutral lipid droplet accumulation in fatty and diabetic fatty. There were shifts towards a higher cross-sectional-area (CSA) of myosin heavy chain isoforms (MyHC)-2A fibers in fatty and diabetic fatty compared with control rats (P = 0.002 and P<0.001, respectively) and a smaller CSA of MyHC-2X in fatty compared with diabetic fatty and control rats (P<0.001 and P<0.001, respectively). The phosphorylated total-protein-kinase-B (pAKT)/AKT ratio was higher in fatty (182±58%,P = 0.03), but not in diabetic fatty when compared with controls and monocarboxylate-transporter-1 was higher in diabetic fatty (147±36%,P = 0.04), but not in fatty. Conclusions Diaphragmatic force is increased in Zucker obese rats before and after mechanical ventilation, and is associated with activation of AKT pathway signaling and complex changes in morphology.
Collapse
Affiliation(s)
- Audrey De Jong
- Sorbonne Universités UPMC Univ Paris 06, UMR INSERM-UPMC 1166, IHU ICAN, Paris, France
- Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Department of Anesthesia and Critical Care B, Hôpital Saint-Eloi, CHU de Montpellier, France
- * E-mail:
| | - Serge Carreira
- Sorbonne Universités UPMC Univ Paris 06, UMR INSERM-UPMC 1166, IHU ICAN, Paris, France
- Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Na Na
- Sorbonne Universités UPMC Univ Paris 06, UMR INSERM-UPMC 1166, IHU ICAN, Paris, France
- Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Aude Carillion
- Sorbonne Universités UPMC Univ Paris 06, UMR INSERM-UPMC 1166, IHU ICAN, Paris, France
- Department of Anesthesiology and Critical Care Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Cheng Jiang
- Sorbonne Universités UPMC Univ Paris 06, UMR INSERM-UPMC 1166, IHU ICAN, Paris, France
- Emergency Department, Zonghnan University Hospital, Wuhan University, Wuhan, The People’s Republic of China
| | - Maud Beuvin
- Sorbonne Universités UPMC Univ Paris 06, Inserm, CNRS, Centre de Recherche en Myologie (CRM), GH Pitié Salpêtrière, Paris, France
| | - Jean-Marc Lacorte
- Department of Endocrinologic and Oncologic Biochemistry, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Bonnefont-Rousselot
- Sorbonne Universités UPMC Univ Paris 06, UMR INSERM-UPMC 1166, IHU ICAN, Paris, France
- Department of Metabolic Biochemistry, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Université Paris Descartes, Faculty of Pharmacy, Paris, France
| | - Bruno Riou
- Sorbonne Universités UPMC Univ Paris 06, UMR INSERM-UPMC 1166, IHU ICAN, Paris, France
- Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Catherine Coirault
- Sorbonne Universités UPMC Univ Paris 06, Inserm, CNRS, Centre de Recherche en Myologie (CRM), GH Pitié Salpêtrière, Paris, France
| |
Collapse
|
64
|
Zhu X, van Hees HWH, Heunks L, Wang F, Shao L, Huang J, Shi L, Ma S. The role of calpains in ventilator-induced diaphragm atrophy. Intensive Care Med Exp 2017; 5:14. [PMID: 28290154 PMCID: PMC5348482 DOI: 10.1186/s40635-017-0127-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 02/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background Controlled mechanical ventilation (CMV) is associated with diaphragm dysfunction. Dysfunction results from muscle atrophy and injury of diaphragm muscle fibers. Enhanced proteolysis and reduced protein synthesis play an important role in the development of atrophy. The current study is to evaluate the effects of the calpains inhibitor calpeptin on the development of diaphragm atrophy and activation of key enzymes of the ubiquitin-proteasome pathway in rats under CMV. Methods Three groups of rats were studied: control animals (CON, n = 8), rats subjected to 24 h of MV (CMV, n = 8), and rats subjected to 24 h of MV after administration of the calpain inhibitor calpeptin (CMVC, n = 8). The diaphragm was analyzed for calpain activity, myosin heavy chain (MHC) content, and cross-sectional area (CSA) of diaphragmatic muscle fibers as a marker for muscle atrophy. In addition, key enzymes of the ubiquitin-proteasome pathway (MAFbx and MuRF1) were also studied. Results CMV resulted in loss of both MHCfast and MHCslow. Furthermore, the CSA of diaphragmatic muscle fibers was significantly decreased after 24 h of CMV. However, calpain inhibitor calpeptin prevented loss of MHC and CSA after CMV. In addition, calpeptin prevented the increase in protein expression of calpain1 and calpain2 and reduced calpain activity as indicated by reduced generation of the calpain cleavage product αII-spectrin in the diaphragm. CMV-induced upregulation of both MAFbx and MuRF1 protein levels was attenuated by treatment with calpeptin. Conclusions The calpain inhibitor calpeptin prevents MV-induced muscle atrophy. In addition, calpeptin attenuated the expression of key proteolytic enzymes known to be involved in ventilator-induced diaphragm atrophy, including MAFbx and MuRF1.
Collapse
Affiliation(s)
- Xiaoping Zhu
- Department of Pulmonary Diseases, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Hieronymus W H van Hees
- Department of Pulmonary Diseases, Radboud University Medical Centre, Postbox 9101, Nijmegen, 6500 HB, the Netherlands
| | - Leo Heunks
- Intensive Care Medicine, Radboud University Medical Centre, Postbox 9101, Nijmegen, 6500 HB, the Netherlands
| | - Feifei Wang
- NingXia Medical University, Yinchuan, 750004, China
| | - Lei Shao
- Department of Pulmonary Diseases, Shanghai East Hospital, Tongji University, Shanghai, 200120, China
| | - Jiaru Huang
- NingXia Medical University, Yinchuan, 750004, China
| | - Lei Shi
- NingXia Medical University, Yinchuan, 750004, China
| | - Shaolin Ma
- Department of Intensive Care Unit, Shanghai East Hospital, Tongji University, Shanghai, 200120, China.
| |
Collapse
|
65
|
LaRosa DA, Ellery SJ, Walker DW, Dickinson H. Understanding the Full Spectrum of Organ Injury Following Intrapartum Asphyxia. Front Pediatr 2017; 5:16. [PMID: 28261573 PMCID: PMC5313537 DOI: 10.3389/fped.2017.00016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Abstract
Birth asphyxia is a significant global health problem, responsible for ~1.2 million neonatal deaths each year worldwide. Those who survive often suffer from a range of health issues including brain damage-manifesting as cerebral palsy (CP)-respiratory insufficiency, cardiovascular collapse, and renal dysfunction, to name a few. Although the majority of research is directed toward reducing the brain injury that results from intrapartum birth asphyxia, the multi-organ injury observed in surviving neonates is of equal importance. Despite the advent of hypothermia therapy for the treatment of hypoxic-ischemic encephalopathy (HIE), treatment options following asphyxia at birth remain limited, particularly in low-resource settings where the incidence of birth asphyxia is highest. Furthermore, although cooling of the neonate results in improved neurological outcomes for a small proportion of treated infants, it does not provide any benefit to the other organ systems affected by asphyxia at birth. The aim of this review is to summarize the current knowledge of the multi-organ effects of intrapartum asphyxia, with particular reference to the findings from our laboratory using the precocial spiny mouse to model birth asphyxia. Furthermore, we reviewed the current treatments available for neonates who have undergone intrapartum asphyxia, and highlight the emergence of maternal dietary creatine supplementation as a preventative therapy, which has been shown to provide multi-organ protection from birth asphyxia-induced injury in our preclinical studies. This cheap and effective nutritional supplement may be the key to reducing birth asphyxia-induced death and disability, particularly in low-resource settings where current treatments are unavailable.
Collapse
Affiliation(s)
- Domenic A LaRosa
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University, Melbourne, VIC, Australia; Department of Pediatrics, The Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Stacey J Ellery
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University , Melbourne, VIC , Australia
| | - David W Walker
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University , Melbourne, VIC , Australia
| | - Hayley Dickinson
- Ritchie Centre, Department of Obstetrics and Gynaecology, Hudson Institute of Medical Research, Monash University , Melbourne, VIC , Australia
| |
Collapse
|
66
|
Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies. J Clin Med 2016; 5:jcm5120113. [PMID: 27929389 PMCID: PMC5184786 DOI: 10.3390/jcm5120113] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022] Open
Abstract
The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.
Collapse
|
67
|
Bruells CS, Marx G. [Diaphragm dysfunction : Facts for clinicians]. Med Klin Intensivmed Notfmed 2016; 113:526-532. [PMID: 27766377 DOI: 10.1007/s00063-016-0226-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 08/04/2016] [Accepted: 08/23/2016] [Indexed: 01/29/2023]
Abstract
Diaphragm function is crucial for patient outcome in the ICU setting and during the treatment period. The occurrence of an insufficiency of the respiratory pump, which is predominantly formed by the diaphragm, may result in intubation after failure of noninvasive ventilation. Especially patients suffering from chronic obstructive pulmonary disease are in danger of hypercapnic respiratory failure. Changes in biomechanical properties and fiber texture of the diaphragm are further cofactors directly leading to a need for intubation and mechanical ventilation. After intubation and the following inactivity the diaphragm is subject to profound pathophysiologic changes resulting in atrophy and dysfunction. Besides this inactivity-triggered mechanism (termed as ventilator-induced diaphragmatic dysfunction) multiple factors, comorbidities, pharmaceutical agents and additional hits during the ICU treatment, especially the occurrence of sepsis, influence diaphragm homeostasis and can lead to weaning failure. During the weaning process monitoring of diaphragm function can be done with invasive methods - ultrasound is increasingly established to monitor diaphragm contraction, but further and better powered studies are in need to prove its value as a diagnostic tool.
Collapse
Affiliation(s)
- C S Bruells
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| |
Collapse
|
68
|
Ogilvie H, Cacciani N, Akkad H, Larsson L. Targeting Heat Shock Proteins Mitigates Ventilator Induced Diaphragm Muscle Dysfunction in an Age-Dependent Manner. Front Physiol 2016; 7:417. [PMID: 27729867 PMCID: PMC5037190 DOI: 10.3389/fphys.2016.00417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 09/05/2016] [Indexed: 01/25/2023] Open
Abstract
Intensive care unit (ICU) patients are often overtly subjected to mechanical ventilation and immobilization, which leads to impaired limb and respiratory muscle function. The latter, termed ventilator-induced diaphragm dysfunction (VIDD) has recently been related to compromised heat shock protein (Hsp) activation. The administration of a pharmacological drug BGP-15 acting as a Hsp chaperone co-inducer has been found to partially alleviate VIDD in young rats. Considering that the mean age in the ICU is increasing, we aimed to explore whether the beneficial functional effects are also present in old rats. For that, we exposed young (7–8 months) and old (28–32 months) rats to 5-day controlled mechanical ventilation and immobilization with or without systemic BGP-15 administration. We then dissected diaphragm muscles, membrane–permeabilized bundles and evaluated the contractile function at single fiber level. Results confirmed that administration of BGP-15 restored the force-generating capacity of isolated muscle cells from young rats in conjunction with an increased expression of Hsp72. On the other hand, our results highlighted that old rats did not positively respond to the BGP-15 treatment. Therefore, it is of crucial importance to comprehend in more depth the effect of VIDD on diaphragm function and ascertain any further age-related differences.
Collapse
Affiliation(s)
- Hannah Ogilvie
- Basic and Clinical Muscle Biology, Department of Physiology and Pharmacology, Karolinska Institutet Stockholm, Sweden
| | - Nicola Cacciani
- Basic and Clinical Muscle Biology, Department of Physiology and Pharmacology, Karolinska Institutet Stockholm, Sweden
| | - Hazem Akkad
- Basic and Clinical Muscle Biology, Department of Physiology and Pharmacology, Karolinska Institutet Stockholm, Sweden
| | - Lars Larsson
- Basic and Clinical Muscle Biology, Department of Physiology and Pharmacology, Karolinska InstitutetStockholm, Sweden; Department of Clinical Neuroscience, Clinical Neurophysiology, Karolinska InstitutetStockholm, Sweden
| |
Collapse
|
69
|
Wilcox SR. Corticosteroids and neuromuscular blockers in development of critical illness neuromuscular abnormalities: A historical review. J Crit Care 2016; 37:149-155. [PMID: 27736708 DOI: 10.1016/j.jcrc.2016.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 01/28/2023]
Abstract
Weakness is common in critically ill patients, associated with prolonged mechanical ventilation and increased mortality. Corticosteroids and neuromuscular blockade (NMB) administration have been implicated as etiologies of acquired weakness in the intensive care unit. Medical literature since the 1970s is replete with case reports and small case series of patients with weakness after receiving high-dose corticosteroids, prolonged NMB, or both. Several risk factors for weakness appear in the early literature, including large doses of steroids, the dose and duration of NMB, hyperglycemia, and the duration of mechanical ventilation. With improved quality of data, however, the association between weakness and steroids or NMB wanes. This may reflect changes in clinical practice, such as a reduction in steroid dosing, use of cisatracurium besylate instead of aminosteroid NMBs, improved glycemic control, or trends in minimizing mechanical ventilatory support. Thus, based on the most recent and high-quality literature, neither corticosteroids in commonly used doses nor NMB is associated with increased duration of mechanical ventilation, the greatest morbidity of weakness. Minimizing ventilator support as soon as the patient's condition allows may be associated with a reduction in weakness-related morbidity.
Collapse
Affiliation(s)
- Susan R Wilcox
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine and Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.
| |
Collapse
|
70
|
Berger D, Bloechlinger S, von Haehling S, Doehner W, Takala J, Z'Graggen WJ, Schefold JC. Dysfunction of respiratory muscles in critically ill patients on the intensive care unit. J Cachexia Sarcopenia Muscle 2016; 7:403-12. [PMID: 27030815 PMCID: PMC4788634 DOI: 10.1002/jcsm.12108] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/18/2015] [Accepted: 01/27/2016] [Indexed: 12/13/2022] Open
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.
Collapse
Affiliation(s)
- David Berger
- Department of Intensive Care Medicine, Inselspital University Hospital of Bern Bern Switzerland
| | - Stefan Bloechlinger
- Department of Intensive Care Medicine, Inselspital University Hospital of Bern Bern Switzerland; Department of Clinical Cardiology, Inselspital University Hospital of Bern Bern Switzerland
| | - Stephan von Haehling
- Department of Cardiology and Center for Innovative Clinical Trials University of Göttingen Göttingen Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin Charite Universitätsmedizin Berlin Berlin Germany
| | - Jukka Takala
- Department of Intensive Care Medicine, Inselspital University Hospital of Bern Bern Switzerland
| | - Werner J Z'Graggen
- Department of Neurosurgery and Dept. of Neurology, Inselspital University Hospital of Bern Bern Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital University Hospital of Bern Bern Switzerland
| |
Collapse
|
71
|
Bhat P, Peacock JL, Rafferty GF, Hannam S, Greenough A. Prediction of infant extubation outcomes using the tension-time index. Arch Dis Child Fetal Neonatal Ed 2016; 101:F444-7. [PMID: 26802111 DOI: 10.1136/archdischild-2015-309264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/27/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The tension-time index of the diaphragm (TTdi) is a composite assessment of the load on and the capacity of the diaphragm. TTmus is a non-invasive tension-time index of the respiratory muscles. Our aim was to determine whether TTdi or TTmus predicted extubation outcome and performed better than respiratory muscle strength (Pimax, Pdimax), respiratory drive (P0.1) and work of breathing (transdiaphragmatic pressure-time product (PTPdi)) or routinely available clinical data. DESIGN Prospective study. SETTING Tertiary neonatal intensive care unit. PATIENTS Sixty infants, median gestation age 35 (range 23-42) weeks and postnatal age of 55 (range 1-115) days. INTERVENTIONS Airway occlusions were performed to measure Pimax, Pdimax and P0.1. TTdi and PTPdi were derived from measurements of transdiaphragmatic pressure. TTmus was derived from airway pressure measurements. Measurements were made within 6 h of extubation. MAIN OUTCOME MEASURES Extubation failure defined as reintubation within 48 h of extubation. RESULTS Twelve infants failed extubation. The infants who failed extubation were significantly more immature (medians 25 vs 37 weeks) and of greater postnatal age (23 vs 5 days) and had higher TTdi (0.15 vs 0.04) and TTmus (0.17 vs 0.08). TTdi and TTmus were only significantly better predictors than the peak inflation pressure immediately prior to extubation and did not perform significantly better than gestational age or birth weight. CONCLUSIONS Assessment of TTdi and TTmus cannot be recommended for use in routine clinical practice.
Collapse
Affiliation(s)
- Prashanth Bhat
- Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Janet L Peacock
- Division of Health and Social Care Research, King's College London, London, UK National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Gerrard F Rafferty
- Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Simon Hannam
- Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| |
Collapse
|
72
|
Bruells CS, Breuer T, Maes K, Bergs I, Bleilevens C, Marx G, Weis J, Gayan-Ramirez G, Rossaint R. Influence of weaning methods on the diaphragm after mechanical ventilation in a rat model. BMC Pulm Med 2016; 16:127. [PMID: 27558126 PMCID: PMC4997706 DOI: 10.1186/s12890-016-0285-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/11/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mechanical ventilation (MV) is associated with diaphragm weakness, a phenomenon termed ventilator-induced diaphragmatic dysfunction. Weaning should balance diaphragmatic loading as well as prevention of overload after MV. The weaning methods pressure support ventilation (PSV) and spontaneous breathing trials (SBT) lead to gradual or intermittent reloading of a weak diaphragm, respectively. This study investigated which weaning method allows more efficient restoration of diaphragm homeostasis. METHODS Rats (n = 8 per group) received 12 h of MV followed by either 12 h of pressure support ventilation (PSV) or intermittent spontaneous breathing trials (SBT) and were compared to rats euthanized after 12 h MV (CMV) and to acutely euthanized rats (CON). Force generation, activity of calpain-1 and caspase-3, oxidative stress, and markers of protein synthesis (phosphorylated AKT to total AKT) were measured in the diaphragm. RESULTS Reduction of diaphragmatic force caused by CMV compared to CON was worsened with PSV and SBT (both p < 0.05 vs. CON and CMV). Both PSV and SBT reversed oxidative stress and calpain-1 activation caused by CMV. Reduced pAKT/AKT was observed after CMV and both weaning procedures. CONCLUSIONS MV resulted in a loss of diaphragmatic contractility, which was aggravated in SBT and PSV despite reversal of oxidative stress and proteolysis.
Collapse
Affiliation(s)
- Christian S Bruells
- Department of Intensive and Intermediate Care, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Thomas Breuer
- Department of Intensive and Intermediate Care, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany. .,Department of Anaesthesiology, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Karen Maes
- Laboratory of Pneumology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ingmar Bergs
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Christian Bleilevens
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Gernot Marx
- Department of Intensive and Intermediate Care, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Joachim Weis
- Institute of Neuropathology, University Hospital of the RWTH Aachen, Aachen, Germany
| | | | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| |
Collapse
|
73
|
Dot I, Pérez-Teran P, Samper MA, Masclans JR. Diaphragm Dysfunction in Mechanically Ventilated Patients. Arch Bronconeumol 2016; 53:150-156. [PMID: 27553431 DOI: 10.1016/j.arbres.2016.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/04/2016] [Accepted: 07/17/2016] [Indexed: 12/14/2022]
Abstract
Muscle involvement is found in most critical patients admitted to the intensive care unit (ICU). Diaphragmatic muscle alteration, initially included in this category, has been differentiated in recent years, and a specific type of muscular dysfunction has been shown to occur in patients undergoing mechanical ventilation. We found this muscle dysfunction to appear in this subgroup of patients shortly after the start of mechanical ventilation, observing it to be mainly associated with certain control modes, and also with sepsis and/or multi-organ failure. Although the specific etiology of process is unknown, the muscle presents oxidative stress and mitochondrial changes. These cause changes in protein turnover, resulting in atrophy and impaired contractility, and leading to impaired functionality. The term 'ventilator-induced diaphragm dysfunction' was first coined by Vassilakopoulos et al. in 2004, and this phenomenon, along with injury cause by over-distention of the lung and barotrauma, represents a challenge in the daily life of ventilated patients. Diaphragmatic dysfunction affects prognosis by delaying extubation, prolonging hospital stay, and impairing the quality of life of these patients in the years following hospital discharge. Ultrasound, a non-invasive technique that is readily available in most ICUs, could be used to diagnose this condition promptly, thus preventing delays in starting rehabilitation and positively influencing prognosis in these patients.
Collapse
Affiliation(s)
- Irene Dot
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España
| | - Purificación Pérez-Teran
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España
| | - Manuel-Andrés Samper
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España
| | - Joan-Ramon Masclans
- Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar de Barcelona, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM)-GREPAC, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España; CIBERES, España.
| |
Collapse
|
74
|
Sigurta' A, Zambelli V, Bellani G. Renin-angiotensin system in ventilator-induced diaphragmatic dysfunction: Potential protective role of Angiotensin (1-7). Med Hypotheses 2016; 94:132-7. [PMID: 27515219 DOI: 10.1016/j.mehy.2016.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 12/14/2022]
Abstract
Ventilator-induced diaphragmatic dysfunction is a feared complication of mechanical ventilation that adversely affects the outcome of intensive care patients. Human and animal studies demonstrate atrophy and ultrastructural alteration of diaphragmatic muscular fibers attributable to increased oxidative stress, depression of the anabolic pathway regulated by Insulin-like growing factor 1 and increased proteolysis. The renin-angiotensin system, through its main peptide Angiotensin II, plays a major role in skeletal muscle diseases, mainly increasing oxidative stress and inducing insulin resistance, atrophy and fibrosis. Conversely, its counter-regulatory peptide Angiotensin (1-7) has a protective role in these processes. Recent data on rodent models show that renin-angiotensin system is activated after mechanical ventilation and that infusion of Angiotensin II induces diaphragmatic skeletal muscle atrophy. Given: (A) common pathways shared by ventilator-induced diaphragmatic dysfunction and skeletal muscle pathology induced by renin-angiotensin system, (B) evidences of an involvement of renin-angiotensin system in diaphragm atrophy and dysfunction, we hypothesize that renin-angiotensin system plays an important role in ventilator-induced diaphragmatic dysfunction, while Angiotensin (1-7) can have a protective effect on this pathological process. The activation of renin-angiotensin system in ventilator-induced diaphragmatic dysfunction can be demonstrated by quantification of its main components in the diaphragm of ventilated humans or animals. The infusion of Angiotensin (1-7) in an established rodent model of ventilator-induced diaphragmatic dysfunction can be used to test its potential protective role, that can be further confirmed with the infusion of Angiotensin (1-7) antagonists like A-779. Verifying this hypothesis can help in understanding the processes involved in ventilator-induced diaphragmatic dysfunction pathophysiology and open new possibilities for its prevention and treatment.
Collapse
Affiliation(s)
- Anna Sigurta'
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Vanessa Zambelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency, San Gerardo Hospital, Monza, Italy
| |
Collapse
|
75
|
Li LF, Chang YL, Chen NH, Wang CY, Chang GJ, Lin MC, Chang CH, Huang CC, Chuang JH, Yang YP, Chiou SH, Liu YY. Inhibition of Src and forkhead box O1 signaling by induced pluripotent stem-cell therapy attenuates hyperoxia-augmented ventilator-induced diaphragm dysfunction. Transl Res 2016; 173:131-147.e1. [PMID: 27055225 DOI: 10.1016/j.trsl.2016.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/13/2016] [Accepted: 03/15/2016] [Indexed: 11/19/2022]
Abstract
Mechanical ventilation (MV) with hyperoxia is required for providing life support to patients with acute lung injury (ALI). However, MV may cause diaphragm weakness through muscle injury and atrophy, an effect termed ventilator-induced diaphragm dysfunction (VIDD). Src protein tyrosine kinase and class O of forkhead box 1 (FoxO1) mediate acute inflammatory responses and muscle protein degradation induced by oxidative stress. Induced pluripotent stem cells (iPSCs) have been reported to improve hyperoxia-augmented ALI; however, the mechanisms regulating the interactions among VIDD, hyperoxia, and iPSCs are unclear. In this study, we hypothesized that iPSC therapy can ameliorate hyperoxia-augmented VIDD by suppressing the Src-FoxO1 pathway. Male C57BL/6 mice, either wild-type or Src-deficient, aged between 6 and 8 weeks were exposed to MV (6 or 10 mL/kg) with or without hyperoxia for 2-8 h after the administration of 5 × 10(7) cells/kg Oct4/Sox2/Parp1 mouse iPSCs or iPSC-derived conditioned medium (iPSC-CM). Nonventilated mice were used as controls. MV during hyperoxia aggravated VIDD, as demonstrated by the increases in Src activation, FoxO1 dephosphorylation, malondialdehyde, caspase-3, atrogin-1 and muscle ring finger-1 production, microtubule-associated protein light chain 3-II, disorganized myofibrils, disrupted mitochondria, autophagy, and myonuclear apoptosis; however, MV with hyperoxia reduced mitochondrial cytochrome C, diaphragm muscle fiber size, and contractility (P < 0.05). Hyperoxia-exacerbated VIDD was attenuated in Src-deficient mice and by iPSCs and iPSC-CM (P < 0.05). Our data indicate that iPSC therapy attenuates MV-induced diaphragmatic injury that occurs during hyperoxia-augmented VIDD by inhibiting the Src-FoxO1 signaling pathway.
Collapse
Affiliation(s)
- Li-Fu Li
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yuh-Lih Chang
- Department of Medical Research & Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ning-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Ying Wang
- Department of Medical Research & Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Hao Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chi Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jen-Hua Chuang
- Department of Medical Research & Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Pin Yang
- Department of Medical Research & Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hwa Chiou
- Department of Medical Research & Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Yang Liu
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan.
| |
Collapse
|
76
|
Jiao GY, Hao LY, Chen L, Gao CE, Feng R, Hu HY, Tan ST, Wang MM, Zhong B, Wang PP. High levels of positive end-expiratory pressure preserve diaphragmatic contractility during acute respiratory distress syndrome in rats. Exp Physiol 2016; 100:967-76. [PMID: 26053378 DOI: 10.1113/ep085083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/02/2015] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Higher levels of positive end-expiratory pressure (PEEP) have recently been used in patients with acute respiratory distress syndrome (ARDS). In normal physiological conditions, the ability of the diaphragm to generate pressure is reduced when the lung volume is elevated beyond its functional residual capacity. It is unknown whether higher levels of PEEP will have a negative impact on diaphragmatic contraction in the presence of the pathophysiology of ARDS. What is the main finding and its importance? Mechanical ventilation with higher levels of PEEP reduced lung injury, improved diaphragmatic contractility and increased the expression of both dihydropyridine receptor and ryanodine receptor in the diaphragms of rats with ARDS. Higher levels of positive end-expiratory pressure (PEEP) have recently been used in patients with acute respiratory distress syndrome (ARDS). In normal physiological conditions, the ability of the diaphragm to generate pressure is reduced when the lung volume is elevated beyond its functional residual capacity. Thus, it is critical to understand whether higher levels of PEEP will have a negative impact on diaphragmatic contraction in the presence of the pathophysiology of ARDS. This study was designed to determine whether higher levels of PEEP reduce diaphragmatic contractility in a rat model of ARDS generated using i.p. lipopolysaccharide. Forty rats were randomly assigned to the following five groups: a control group with no special treatment; an ARDS group with no mechanical ventilation; and three ARDS groups with mechanical ventilation with PEEP at 0, 5 or 10 cmH2 O, respectively. We found that mechanical ventilation with PEEP reduced lung injury, improved diaphragmatic contractility and increased the expression of both dihydropyridine receptor and ryanodine receptor in the diaphragms of rats with ARDS. These changes were most significant at a PEEP of 10 cmH2 O among all applied levels of PEEP. In conclusion, using a rat ARDS model, this study confirmed that diaphragmatic contractility was preserved by mechanical ventilation with high levels of PEEP.
Collapse
Affiliation(s)
- Guang-Yu Jiao
- Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Li-Ying Hao
- Department of Pharmaceutical Toxicology, School of Pharmaceutical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Lie Chen
- Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Chun-E Gao
- Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Rui Feng
- Department of Pharmaceutical Toxicology, School of Pharmaceutical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Hui-Yuan Hu
- Department of Pharmaceutical Toxicology, School of Pharmaceutical Sciences, China Medical University, Shenyang, People's Republic of China
| | - Shu-Tao Tan
- Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Meng-Meng Wang
- Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Bin Zhong
- Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Ping-Ping Wang
- Respiratory Department and Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| |
Collapse
|
77
|
Hussain SNA, Cornachione AS, Guichon C, Al Khunaizi A, de Souza Leite F, Petrof BJ, Mofarrahi M, Moroz N, de Varennes B, Goldberg P, Rassier DE. Prolonged controlled mechanical ventilation in humans triggers myofibrillar contractile dysfunction and myofilament protein loss in the diaphragm. Thorax 2016; 71:436-45. [DOI: 10.1136/thoraxjnl-2015-207559] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/06/2016] [Indexed: 12/16/2022]
|
78
|
Abstract
BACKGROUND The effects of different modes of mechanical ventilation in the same ventilatory support level on ventilator-induced diaphragm dysfunction onset were assessed in healthy rabbits. METHODS Twenty New Zealand rabbits were randomly assigned to 4 groups (n = 5 in each group). Group 1: no mechanical ventilation; group 2: controlled mechanical ventilation (CMV) for 24 hours; group 3: assist/control ventilation (A/C) mode for 24 hours; group 4: high-level pressure support ventilation (PSV) mode for 24 hours. Heart rate, mean arterial blood pressure, PH, partial pressure of arterial oxygen/fraction of inspired oxygen and partial pressure of arterial carbon dioxide were monitored and diaphragm electrical activity was analyzed in the 4 groups. Caspase-3 was evaluated by protein analysis and diaphragm ultra structure was assessed by electron microscopy. RESULTS The centroid frequency and the ratio of high frequency to low frequency were significantly reduced in the CMV, A/C and PSV groups (P < 0.001). The percent change in centroid frequency was significantly lower in the PSV group than in the CMV and A/C groups (P = 0.001 and P = 0.028, respectively). Electromyography of diaphragm integral amplitude decreased by 90% ± 1.48%, 67.8% ± 3.13% and 70.2% ± 4.72% in the CMV, A/C and PSV groups, respectively (P < 0.001). Caspase-3 protein activation was attenuated in the PSV group compared with the CMV and A/C groups (P = 0.035 and P = 0.033, respectively). Irregular swelling of mitochondria along with fractured and fuzzy cristae was observed in the CMV group, whereas mitochondrial cristae were dense and rich in the PSV group. The mitochondrial injury scores (Flameng scores) in the PSV group were the lowest among the 3 ventilatory groups (0.93 ± 0.09 in PSV versus 2.69 ± 0.05 in the CMV [P < 0.01] and PSV versus A/C groups [2.02 ± 0.08, P < 0.01]). CONCLUSIONS The diaphragm myoelectric activity was reduced in the PSV group, although excessive oxidative stress and ultra-structural changes of diaphragm were found. However, partial diaphragm electrical activity was retained and diaphragm injury was minimized using the PSV mode.
Collapse
|
79
|
Maternal Creatine Supplementation during Pregnancy Prevents Long-Term Changes in Diaphragm Muscle Structure and Function after Birth Asphyxia. PLoS One 2016; 11:e0149840. [PMID: 26930669 PMCID: PMC4773130 DOI: 10.1371/journal.pone.0149840] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/14/2016] [Indexed: 11/03/2022] Open
Abstract
Using a model of birth asphyxia, we previously reported significant structural and functional deficits in the diaphragm muscle in spiny mice, deficits that are prevented by supplementing the maternal diet with 5% creatine from mid-pregnancy. The long-term effects of this exposure are unknown. Pregnant spiny mice were fed control or 5% creatine-supplemented diet for the second half of pregnancy, and fetuses were delivered by caesarean section with or without 7.5 min of in-utero asphyxia. Surviving pups were raised by a cross-foster dam until 33±2 days of age when they were euthanized to obtain the diaphragm muscle for ex-vivo study of twitch tension and muscle fatigue, and for structural and enzymatic analyses. Functional analysis of the diaphragm revealed no differences in single twitch contractile parameters between any groups. However, muscle fatigue, induced by stimulation of diaphragm strips with a train of pulses (330 ms train/sec, 40 Hz) for 300 sec, was significantly greater for asphyxia pups compared with controls (p<0.05), and this did not occur in diaphragms of creatine + asphyxia pups. Birth asphyxia resulted in a significant increase in the proportion of glycolytic, fast-twitch fibres and a reduction in oxidative capacity of Type I and IIb fibres in male offspring, as well as reduced cross-sectional area of all muscle fibre types (Type I, IIa, IIb/d) in both males and females at 33 days of age. None of these changes were observed in creatine + asphyxia animals. Thus, the changes in diaphragm fatigue and structure induced by birth asphyxia persist long-term but are prevented by maternal creatine supplementation.
Collapse
|
80
|
Talbert EE, Smuder AJ, Kwon OS, Sollanek KJ, Wiggs MP, Powers SK. Blockage of the Ryanodine Receptor via Azumolene Does Not Prevent Mechanical Ventilation-Induced Diaphragm Atrophy. PLoS One 2016; 11:e0148161. [PMID: 26849371 PMCID: PMC4744044 DOI: 10.1371/journal.pone.0148161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/13/2016] [Indexed: 11/18/2022] Open
Abstract
Mechanical ventilation (MV) is a life-saving intervention for patients in respiratory failure. However, prolonged MV causes the rapid development of diaphragm muscle atrophy, and diaphragmatic weakness may contribute to difficult weaning from MV. Therefore, developing a therapeutic countermeasure to protect against MV-induced diaphragmatic atrophy is important. MV-induced diaphragm atrophy is due, at least in part, to increased production of reactive oxygen species (ROS) from diaphragm mitochondria and the activation of key muscle proteases (i.e., calpain and caspase-3). In this regard, leakage of calcium through the ryanodine receptor (RyR1) in diaphragm muscle fibers during MV could result in increased mitochondrial ROS emission, protease activation, and diaphragm atrophy. Therefore, these experiments tested the hypothesis that a pharmacological blockade of the RyR1 in diaphragm fibers with azumolene (AZ) would prevent MV-induced increases in mitochondrial ROS production, protease activation, and diaphragmatic atrophy. Adult female Sprague-Dawley rats underwent 12 hours of full-support MV while receiving either AZ or vehicle. At the end of the experiment, mitochondrial ROS emission, protease activation, and fiber cross-sectional area were determined in diaphragm muscle fibers. Decreases in muscle force production following MV indicate that the diaphragm took up a sufficient quantity of AZ to block calcium release through the RyR1. However, our findings reveal that AZ treatment did not prevent the MV-induced increase in mitochondrial ROS emission or protease activation in the diaphragm. Importantly, AZ treatment did not prevent MV-induced diaphragm fiber atrophy. Thus, pharmacological inhibition of the RyR1 in diaphragm muscle fibers is not sufficient to prevent MV-induced diaphragm atrophy.
Collapse
Affiliation(s)
- Erin E. Talbert
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Ashley J. Smuder
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States of America
| | - Oh Sung Kwon
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States of America
| | - Kurt J. Sollanek
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States of America
| | - Michael P. Wiggs
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States of America
| | - Scott K. Powers
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, United States of America
| |
Collapse
|
81
|
Smuder AJ, Gonzalez-Rothi EJ, Kwon OS, Morton AB, Sollanek KJ, Powers SK, Fuller DD. Cervical spinal cord injury exacerbates ventilator-induced diaphragm dysfunction. J Appl Physiol (1985) 2016; 120:166-77. [PMID: 26472866 PMCID: PMC4719055 DOI: 10.1152/japplphysiol.00488.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/07/2015] [Indexed: 01/06/2023] Open
Abstract
Cervical spinal cord injury (SCI) can dramatically impair diaphragm muscle function and often necessitates mechanical ventilation (MV) to maintain adequate pulmonary gas exchange. MV is a life-saving intervention. However, prolonged MV results in atrophy and impaired function of the diaphragm. Since cervical SCI can also trigger diaphragm atrophy, it may create preconditions that exacerbate ventilator-induced diaphragm dysfunction (VIDD). Currently, no drug therapy or clinical standard of care exists to prevent or minimize diaphragm dysfunction following SCI. Therefore, we first tested the hypothesis that initiating MV acutely after cervical SCI will exacerbate VIDD and enhance proteolytic activation in the diaphragm to a greater extent than either condition alone. Rats underwent controlled MV for 12 h following acute (∼24 h) cervical spinal hemisection injury at C2 (SCI). Diaphragm tissue was then harvested for comprehensive functional and molecular analyses. Second, we determined if antioxidant therapy could mitigate MV-induced diaphragm dysfunction after cervical SCI. In these experiments, SCI rats received antioxidant (Trolox, a vitamin E analog) or saline treatment prior to initiating MV. Our results demonstrate that compared with either condition alone, the combination of SCI and MV resulted in increased diaphragm atrophy, contractile dysfunction, and expression of atrophy-related genes, including MuRF1. Importantly, administration of the antioxidant Trolox attenuated proteolytic activation, fiber atrophy, and contractile dysfunction in the diaphragms of SCI + MV animals. These findings provide evidence that cervical SCI greatly exacerbates VIDD, but antioxidant therapy with Trolox can preserve diaphragm contractile function following acute SCI.
Collapse
Affiliation(s)
- Ashley J Smuder
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida; and
| | | | - Oh Sung Kwon
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida; and
| | - Aaron B Morton
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida; and
| | - Kurt J Sollanek
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida; and
| | - Scott K Powers
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida; and
| | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, Florida
| |
Collapse
|
82
|
McCrory MC, Lee KJ, Scanlon MC, Wakeham MK. Predictors of need for mechanical ventilation at discharge after tracheostomy in the PICU. Pediatr Pulmonol 2016; 51:53-9. [PMID: 25823590 DOI: 10.1002/ppul.23195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/21/2015] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to determine factors predictive of need for mechanical ventilation (MV) upon discharge from the pediatric intensive care unit (PICU) among patients who receive a tracheostomy during their stay. METHODS This was a retrospective cohort study using the Virtual PICU Systems (VPS) database. Patients <18 years old admitted between 2009-2011 who required MV for at least 3 days and received a tracheostomy during their PICU stay were included. RESULTS A total of 680 pediatric patients from 74 PICUs were included, of whom 347 (51%) remained on MV at the time of PICU discharge. Neonates (30/38, 79%) and infants (129/203, 64%) required MV at PICU discharge after tracheostomy more often than adolescents (66/141, 47%) and children (122/298, 41%). Time on MV pre-tracheostomy was longer among those who required MV at discharge (median 18.3 vs. 13.8 days, P < 0.0001); however, number of failed extubations was similar (median 1 for both groups, P = 0.97). On mixed-effects multivariable regression analysis, the age categories of neonate (OR 2.9, 95%CI 1.1-7.6, P = 0.03), and infant (OR 1.7, 95%CI 1.1-2.8, P = 0.03), and ventilator days prior to tracheostomy (OR 1.01, 95%CI 1.0-1.02, P = 0.01) were significantly associated with increased odds of MV upon PICU discharge, while being a trauma admission was associated with decreased odds (OR 0.45, 95%CI 0.28-0.73, P = 0.001). CONCLUSIONS Younger patients and those with prolonged courses of MV prior to tracheostomy are more likely to continue to need MV upon PICU discharge.
Collapse
Affiliation(s)
- Michael C McCrory
- Section on Pediatric Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - K Jane Lee
- Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Martin K Wakeham
- Department of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
83
|
Santin JM, Hartzler LK. Control of lung ventilation following overwintering conditions in bullfrogs, Lithobates catesbeianus. J Exp Biol 2016; 219:2003-14. [DOI: 10.1242/jeb.136259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/14/2016] [Indexed: 12/19/2022]
Abstract
Ranid frogs in northern latitudes survive winter at cold temperatures in aquatic habitats often completely covered by ice. Cold-submerged frogs survive aerobically for several months relying exclusively on cutaneous gas exchange while maintaining temperature-specific acid-base balance. Depending on the overwintering hibernaculum, frogs in northern latitudes could spend several months without access to air, need to breathe, or chemosensory drive to use neuromuscular processes that regulate and enable pulmonary ventilation. Therefore, we performed experiments to determine whether aspects of the respiratory control system of bullfrogs, Lithobates catesbeianus, are maintained or suppressed following minimal use of air breathing in overwintering environments. Based on the necessity for control of lung ventilation in early spring, we hypothesized that critical components of the respiratory control system of bullfrogs would be functional following simulated overwintering. We found that bullfrogs recently removed from simulated overwintering environments exhibited similar resting ventilation when assessed at 24°C compared to warm-acclimated control bullfrogs. Additionally, ventilation met resting metabolic and, presumably, acid-base regulation requirements, indicating preservation of basal respiratory function despite prolonged disuse in the cold. Recently emerged bullfrogs underwent similar increases in ventilation during acute oxygen lack (aerial hypoxia) compared to warm-acclimated frogs; however, CO2-related hyperventilation was significantly blunted following overwintering. Overcoming challenges to gas exchange during overwintering have garnered attention in ectothermic vertebrates, but this study uncovers robust and labile aspects of the respiratory control system at a time point correlating with early spring following minimal/no use of lung breathing in cold-aquatic overwintering habitats.
Collapse
Affiliation(s)
- Joseph M. Santin
- Wright State University, Department of Biological Sciences, 3640 Colonel Glenn. Hwy. Dayton, OH 45435, USA
- Wright State University, Biomedical Sciences PhD Program, 3640 Colonel Glenn. Hwy. Dayton, OH 45435, USA
| | - Lynn K. Hartzler
- Wright State University, Department of Biological Sciences, 3640 Colonel Glenn. Hwy. Dayton, OH 45435, USA
| |
Collapse
|
84
|
Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, Rittayamai N, Lanys A, Tomlinson G, Singh JM, Bolz SS, Rubenfeld GD, Kavanagh BP, Brochard LJ, Ferguson ND. Evolution of Diaphragm Thickness during Mechanical Ventilation. Impact of Inspiratory Effort. Am J Respir Crit Care Med 2015; 192:1080-8. [DOI: 10.1164/rccm.201503-0620oc] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
85
|
Bonnevie T, Villiot-Danger JC, Gravier FE, Dupuis J, Prieur G, Médrinal C. Inspiratory muscle training is used in some intensive care units, but many training methods have uncertain efficacy: a survey of French physiotherapists. J Physiother 2015; 61:204-9. [PMID: 26365266 DOI: 10.1016/j.jphys.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/29/2015] [Accepted: 08/11/2015] [Indexed: 12/15/2022] Open
Abstract
QUESTIONS How common is inspiratory muscle training by physiotherapists in the intensive care unit (ICU)? Which patients receive the training? What methods are used to administer the training? Is maximal inspiratory pressure used to evaluate the need for the training and the patient's outcome after training? DESIGN Cross-sectional survey of all ICUs in France. PARTICIPANTS Two hundred and sixty-five senior physiotherapists. RESULTS The response rate was 99% among eligible units. Therapist experience in ICU was significantly associated with the use of inspiratory muscle training (p=0.02). Therapists mainly used inspiratory muscle training either systematically or specifically in patients who failed to wean from mechanical ventilation. The training was used significantly more in non-sedated patients (p<0.0001). The most commonly nominated technique that respondents claimed to use to apply the training was controlled diaphragmatic breathing (83% of respondents), whereas 13% used evidence-based methods. Among those who applied some form of inspiratory muscle training, 16% assessed maximal inspiratory pressure. Six respondents (2%, 95% CI 1 to 5) used both an evidence-based method to administer inspiratory muscle training and the recommended technique for assessment of inspiratory muscle strength. CONCLUSION Most physiotherapists in French ICUs who apply inspiratory muscle training use methods of uncertain efficacy without assessment of maximal inspiratory pressure. Further efforts need to be made in France to disseminate information regarding evidence-based assessment and techniques for inspiratory muscle training in the ICU. The alignment of inspiratory muscle training practice with evidence could be investigated in other regions.
Collapse
Affiliation(s)
- Tristan Bonnevie
- ADIR Association, Bois-Guillaume; Service de réanimation chirurgicale; Université de Picardie Jules Verne, Amiens
| | | | - Francis-Edouard Gravier
- ADIR Association, Bois-Guillaume; Service réanimation médicale, CHU-Hôpitaux de Rouen, Rouen
| | | | - Guillame Prieur
- Université de Picardie Jules Verne, Amiens; Service de réanimation médico-chirurgicale, Groupe hospitalier du Havre, Montivilliers, France
| | - Clément Médrinal
- Université de Picardie Jules Verne, Amiens; Service de réanimation médico-chirurgicale, Groupe hospitalier du Havre, Montivilliers, France
| |
Collapse
|
86
|
Kwon OS, Smuder AJ, Wiggs MP, Hall SE, Sollanek KJ, Morton AB, Talbert EE, Toklu HZ, Tumer N, Powers SK. AT1 receptor blocker losartan protects against mechanical ventilation-induced diaphragmatic dysfunction. J Appl Physiol (1985) 2015; 119:1033-41. [PMID: 26359481 DOI: 10.1152/japplphysiol.00237.2015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/04/2015] [Indexed: 11/22/2022] Open
Abstract
Mechanical ventilation is a life-saving intervention for patients in respiratory failure. Unfortunately, prolonged ventilator support results in diaphragmatic atrophy and contractile dysfunction leading to diaphragm weakness, which is predicted to contribute to problems in weaning patients from the ventilator. While it is established that ventilator-induced oxidative stress is required for the development of ventilator-induced diaphragm weakness, the signaling pathway(s) that trigger oxidant production remain unknown. However, recent evidence reveals that increased plasma levels of angiotensin II (ANG II) result in oxidative stress and atrophy in limb skeletal muscles. Using a well-established animal model of mechanical ventilation, we tested the hypothesis that increased circulating levels of ANG II are required for both ventilator-induced diaphragmatic oxidative stress and diaphragm weakness. Cause and effect was determined by administering an angiotensin-converting enzyme inhibitor (enalapril) to prevent ventilator-induced increases in plasma ANG II levels, and the ANG II type 1 receptor antagonist (losartan) was provided to prevent the activation of ANG II type 1 receptors. Enalapril prevented the increase in plasma ANG II levels but did not protect against ventilator-induced diaphragmatic oxidative stress or diaphragm weakness. In contrast, losartan attenuated both ventilator-induced oxidative stress and diaphragm weakness. These findings indicate that circulating ANG II is not essential for the development of ventilator-induced diaphragm weakness but that activation of ANG II type 1 receptors appears to be a requirement for ventilator-induced diaphragm weakness. Importantly, these experiments provide the first evidence that the Food and Drug Administration-approved drug losartan may have clinical benefits to protect against ventilator-induced diaphragm weakness in humans.
Collapse
Affiliation(s)
- Oh Sung Kwon
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Ashley J Smuder
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Michael P Wiggs
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Stephanie E Hall
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Kurt J Sollanek
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Aaron B Morton
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Erin E Talbert
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Hale Z Toklu
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida; and Geriatric Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Nihal Tumer
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, Florida; and Geriatric Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Scott K Powers
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida;
| |
Collapse
|
87
|
Affiliation(s)
- Gary C Sieck
- 1 Department of Physiology and Biomedical Engineering Mayo Clinic Rochester, Minnesota
| |
Collapse
|
88
|
Inhibition of forkhead boxO-specific transcription prevents mechanical ventilation-induced diaphragm dysfunction. Crit Care Med 2015; 43:e133-42. [PMID: 25746508 DOI: 10.1097/ccm.0000000000000928] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Mechanical ventilation is a lifesaving measure for patients with respiratory failure. However, prolonged mechanical ventilation results in diaphragm weakness, which contributes to problems in weaning from the ventilator. Therefore, identifying the signaling pathways responsible for mechanical ventilation-induced diaphragm weakness is essential to developing effective countermeasures to combat this important problem. In this regard, the forkhead boxO family of transcription factors is activated in the diaphragm during mechanical ventilation, and forkhead boxO-specific transcription can lead to enhanced proteolysis and muscle protein breakdown. Currently, the role that forkhead boxO activation plays in the development of mechanical ventilation-induced diaphragm weakness remains unknown. DESIGN This study tested the hypothesis that mechanical ventilation-induced increases in forkhead boxO signaling contribute to ventilator-induced diaphragm weakness. SETTING University research laboratory. SUBJECTS Young adult female Sprague-Dawley rats. INTERVENTIONS Cause and effect was determined by inhibiting the activation of forkhead boxO in the rat diaphragm through the use of a dominant-negative forkhead boxO adeno-associated virus vector delivered directly to the diaphragm. MEASUREMENTS AND MAIN RESULTS Our results demonstrate that prolonged (12 hr) mechanical ventilation results in a significant decrease in both diaphragm muscle fiber size and diaphragm-specific force production. However, mechanically ventilated animals treated with dominant-negative forkhead boxO showed a significant attenuation of both diaphragm atrophy and contractile dysfunction. In addition, inhibiting forkhead boxO transcription attenuated the mechanical ventilation-induced activation of the ubiquitin-proteasome system, the autophagy/lysosomal system, and caspase-3. CONCLUSIONS Forkhead boxO is necessary for the activation of key proteolytic systems essential for mechanical ventilation-induced diaphragm atrophy and contractile dysfunction. Collectively, these results suggest that targeting forkhead boxO transcription could be a key therapeutic target to combat ventilator-induced diaphragm dysfunction.
Collapse
|
89
|
Powers SK, Smuder AJ, Fuller D, Levine S. CrossTalk proposal: Mechanical ventilation-induced diaphragm atrophy is primarily due to inactivity. J Physiol 2015; 591:5255-7. [PMID: 24187073 DOI: 10.1113/jphysiol.2013.254680] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
90
|
Verona C, Hackenhaar FS, Teixeira C, Medeiros TM, Alabarse PV, Salomon TB, Shüller ÁK, Maccari JG, Condessa RL, Oliveira RP, Rios Vieira SR, Benfato MS. Blood markers of oxidative stress predict weaning failure from mechanical ventilation. J Cell Mol Med 2015; 19:1253-61. [PMID: 25854285 PMCID: PMC4459841 DOI: 10.1111/jcmm.12475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/24/2014] [Indexed: 11/30/2022] Open
Abstract
Patients undergoing mechanical ventilation (MV) often experience respiratory muscle dysfunction, which complicates the weaning process. There is no simple means to predict or diagnose respiratory muscle dysfunction because diagnosis depends on measurements in muscle diaphragmatic fibre. As oxidative stress is a key mechanism contributing to MV-induced respiratory muscle dysfunction, the aim of this study was to determine if differences in blood measures of oxidative stress in patients who had success and failure in a spontaneous breathing trial (SBT) could be used to predict the outcome of MV. This was a prospective analysis of MV-dependent patients (≥72 hrs; n = 34) undergoing a standard weaning protocol. Clinical, laboratory and oxidative stress analyses were performed. Measurements were made on blood samples taken at three time-points: immediately before the trial, 30 min. into the trial in weaning success (WS) patients, or immediately before return to MV in weaning failure (WF) patients, and 6 hrs after the trial. We found that blood measures of oxidative stress distinguished patients who would experience WF from patients who would experience WS. Before SBT, WF patients presented higher oxidative damage in lipids and higher antioxidant levels and decreased nitric oxide concentrations. The observed differences in measures between WF and WS patients persisted throughout and after the weaning trial. In conclusion, WF may be predicted based on higher malondialdehyde, higher vitamin C and lower nitric oxide concentration in plasma.
Collapse
Affiliation(s)
- Cléber Verona
- Biophysics Department, Program of Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Fernanda S Hackenhaar
- Biophysics Department, Program of Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Cassiano Teixeira
- Department of Critical Care, Moinhos de Vento Hospital, Rio Grande do Sul, Brazil.,Federal University of Health Sciences of Porto Alegre - UFCSPA Medical School, Rio Grande do Sul, Brazil
| | - Tássia M Medeiros
- Biophysics Department, Program of Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Paulo V Alabarse
- Biophysics Department, Program of Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Tiago B Salomon
- Biophysics Department, Program of Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Ártur K Shüller
- Biophysics Department, Program of Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Juçara G Maccari
- Department of Critical Care, Moinhos de Vento Hospital, Rio Grande do Sul, Brazil
| | | | - Roselaine P Oliveira
- Department of Critical Care, Moinhos de Vento Hospital, Rio Grande do Sul, Brazil.,Federal University of Health Sciences of Porto Alegre - UFCSPA Medical School, Rio Grande do Sul, Brazil
| | | | - Mara S Benfato
- Biophysics Department, Program of Cellular and Molecular Biology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| |
Collapse
|
91
|
Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med 2015; 41:642-9. [DOI: 10.1007/s00134-015-3687-3] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/05/2015] [Indexed: 12/30/2022]
|
92
|
Tang H, Smith IJ, Hussain SNA, Goldberg P, Lee M, Sugiarto S, Godinez GL, Singh BK, Payan DG, Rando TA, Kinsella TM, Shrager JB. The JAK-STAT pathway is critical in ventilator-induced diaphragm dysfunction. Mol Med 2015; 20:579-89. [PMID: 25286450 DOI: 10.2119/molmed.2014.00049] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/30/2014] [Indexed: 12/11/2022] Open
Abstract
Mechanical ventilation (MV) is one of the lynchpins of modern intensive-care medicine and is life saving in many critically ill patients. Continuous ventilator support, however, results in ventilation-induced diaphragm dysfunction (VIDD) that likely prolongs patients' need for MV and thereby leads to major associated complications and avoidable intensive care unit (ICU) deaths. Oxidative stress is a key pathogenic event in the development of VIDD, but its regulation remains largely undefined. We report here that the JAK-STAT pathway is activated in MV in the human diaphragm, as evidenced by significantly increased phosphorylation of JAK and STAT. Blockage of the JAK-STAT pathway by a JAK inhibitor in a rat MV model prevents diaphragm muscle contractile dysfunction (by ~85%, p < 0.01). We further demonstrate that activated STAT3 compromises mitochondrial function and induces oxidative stress in vivo, and, interestingly, that oxidative stress also activates JAK-STAT. Inhibition of JAK-STAT prevents oxidative stress-induced protein oxidation and polyubiquitination and recovers mitochondrial function in cultured muscle cells. Therefore, in ventilated diaphragm muscle, activation of JAK-STAT is critical in regulating oxidative stress and is thereby central to the downstream pathogenesis of clinical VIDD. These findings establish the molecular basis for the therapeutic promise of JAK-STAT inhibitors in ventilated ICU patients.
Collapse
Affiliation(s)
- Huibin Tang
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, United States of America.,Veterans Administration Palo Alto Healthcare System, Palo Alto, California, United States of America
| | - Ira J Smith
- Rigel Pharmaceuticals, South San Francisco, California, United States of America
| | - Sabah N A Hussain
- Critical Care Division, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Peter Goldberg
- Critical Care Division, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Myung Lee
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, United States of America.,Veterans Administration Palo Alto Healthcare System, Palo Alto, California, United States of America
| | - Sista Sugiarto
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, United States of America.,Veterans Administration Palo Alto Healthcare System, Palo Alto, California, United States of America
| | - Guillermo L Godinez
- Rigel Pharmaceuticals, South San Francisco, California, United States of America
| | - Baljit K Singh
- Rigel Pharmaceuticals, South San Francisco, California, United States of America
| | - Donald G Payan
- Rigel Pharmaceuticals, South San Francisco, California, United States of America
| | - Thomas A Rando
- Department of Neurology and Neurological Science, Stanford University School of Medicine, Stanford, California, United States of America.,Neurology Service, Veterans Administration Palo Alto Healthcare System, Palo Alto, California, United States of America
| | - Todd M Kinsella
- Rigel Pharmaceuticals, South San Francisco, California, United States of America
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, United States of America.,Veterans Administration Palo Alto Healthcare System, Palo Alto, California, United States of America
| |
Collapse
|
93
|
Sollanek KJ, Smuder AJ, Wiggs MP, Morton AB, Koch LG, Britton SL, Powers SK. Role of intrinsic aerobic capacity and ventilator-induced diaphragm dysfunction. J Appl Physiol (1985) 2015; 118:849-57. [PMID: 25571991 DOI: 10.1152/japplphysiol.00797.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/30/2014] [Indexed: 12/16/2022] Open
Abstract
Prolonged mechanical ventilation (MV) leads to rapid diaphragmatic atrophy and contractile dysfunction, which is collectively termed "ventilator-induced diaphragm dysfunction" (VIDD). Interestingly, endurance exercise training prior to MV has been shown to protect against VIDD. Further, recent evidence reveals that sedentary animals selectively bred to possess a high aerobic capacity possess a similar skeletal muscle phenotype to muscles from endurance trained animals. Therefore, we tested the hypothesis that animals with a high intrinsic aerobic capacity would naturally be afforded protection against VIDD. To this end, animals were selectively bred over 33 generations to create two divergent strains, differing in aerobic capacity: high-capacity runners (HCR) and low-capacity runners (LCR). Both groups of animals were subjected to 12 h of MV and compared with nonventilated control animals within the same strains. As expected, contrasted to LCR animals, the diaphragm muscle from the HCR animals contained higher levels of oxidative enzymes (e.g., citrate synthase) and antioxidant enzymes (e.g., superoxide dismutase and catalase). Nonetheless, compared with nonventilated controls, prolonged MV resulted in significant diaphragmatic atrophy and impaired diaphragm contractile function in both the HCR and LCR animals, and the magnitude of VIDD did not differ between strains. In conclusion, these data demonstrate that possession of a high intrinsic aerobic capacity alone does not afford protection against VIDD. Importantly, these results suggest that endurance exercise training differentially alters the diaphragm phenotype to resist VIDD. Interestingly, levels of heat shock protein 72 did not differ between strains, thus potentially representing an important area of difference between animals with intrinsically high aerobic capacity and exercise-trained animals.
Collapse
Affiliation(s)
- Kurt J Sollanek
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, Florida; and
| | - Ashley J Smuder
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, Florida; and
| | - Michael P Wiggs
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, Florida; and
| | - Aaron B Morton
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, Florida; and
| | - Lauren G Koch
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Steven L Britton
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Scott K Powers
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, Florida; and
| |
Collapse
|
94
|
Andrade PV, dos Santos JM, Silva HCA, Wilbert DD, Cavassani SS, Oliveira-Júnior IS. Influence of hyperoxia and mechanical ventilation in lung inflammation and diaphragm function in aged versus adult rats. Inflammation 2014; 37:486-94. [PMID: 24158570 DOI: 10.1007/s10753-013-9762-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although assist ventilation with FIO2 0.21 is the preferable mode of ventilation in the intensive care unit, sometimes controlled ventilation with hyperoxia is needed. But the impact of this setting has not been extensively studied in elderly subjects. We hypothesized that a high fraction of inspired oxygen (FiO(2)) and controlled mechanical ventilation (CMV) is associated with greater deleterious effects in old compared to adult subjects. Adult and old rats were submitted to CMV with low tidal volume (6 ml/kg) and FiO(2) 1 during 3 or 6 h. Arterial blood gas samples were measured at 0, 60 and 180 min (four groups: old and adult rats, 3 or 6 h of CMV), and additionally at 360 min (two groups: old and adult rats, 6 h of CMV). Furthermore, total protein content (TPC) and tumor necrosis factor-alpha (TNF-α) in bronchoalveolar lavage were assessed; lung tissue was used for malondialdehyde and histological analyses, and the diaphragm for measurement of contractile function. Arterial blood gas analysis showed an initial (60 min) greater PaO(2) in elderly versus adult animals; after that time, elderly animals had lowers pH and PaO(2), and greater PaCO(2). After 3 h of CMV, TPC and TNF-α levels were higher in the old compared with the adult group (P < 0.05). After 6 h of MV, malondialdehyde was significantly higher in elderly compared with the adult animals (P < 0.05). Histological analysis showed leukocyte infiltration and edema, greater in old animals. In diaphragm, twitch contraction with caffeine significantly declined after 6 h of CMV only for the elderly group. These data support the hypothesis that relatively short-term CMV with low tidal volume and hyperoxia has greatest impact in elderly rats, decreasing diaphragmatic contractile function and increasing lung inflammation.
Collapse
Affiliation(s)
- P V Andrade
- Centro de Estudo, Diagnóstico e Investigação de Hipertermia Maligna (CEDHIMA), Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 5 andar, CEP 04024-002, São Paulo, SP, Brazil
| | | | | | | | | | | |
Collapse
|
95
|
Sassoon CSH, Zhu E, Fang L, Sieck GC, Powers SK. Positive end-expiratory airway pressure does not aggravate ventilator-induced diaphragmatic dysfunction in rabbits. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:494. [PMID: 25212227 PMCID: PMC4210557 DOI: 10.1186/s13054-014-0494-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/05/2014] [Indexed: 02/02/2023]
Abstract
Introduction Immobilization of hindlimb muscles in a shortened position results in an accelerated rate of inactivity-induced muscle atrophy and contractile dysfunction. Similarly, prolonged controlled mechanical ventilation (CMV) results in diaphragm inactivity and induces diaphragm muscle atrophy and contractile dysfunction. Further, the application of positive end-expiratory airway pressure (PEEP) during mechanical ventilation would result in shortened diaphragm muscle fibers throughout the respiratory cycle. Therefore, we tested the hypothesis that, compared to CMV without PEEP, the combination of PEEP and CMV would accelerate CMV-induced diaphragm muscle atrophy and contractile dysfunction. To test this hypothesis, we combined PEEP with CMV or with assist-control mechanical ventilation (AMV) and determined the effects on diaphragm muscle atrophy and contractile properties. Methods The PEEP level (8 cmH2O) that did not induce lung overdistension or compromise circulation was determined. In vivo segmental length changes of diaphragm muscle fiber were then measured using sonomicrometry. Sedated rabbits were randomized into seven groups: surgical controls and those receiving CMV, AMV or continuous positive airway pressure (CPAP) with or without PEEP for 2 days. We measured in vitro diaphragmatic force, diaphragm muscle morphometry, myosin heavy-chain (MyHC) protein isoforms, caspase 3, insulin-like growth factor 1 (IGF-1), muscle atrophy F-box (MAFbx) and muscle ring finger protein 1 (MuRF1) mRNA. Results PEEP shortened end-expiratory diaphragm muscle length by 15%, 14% and 12% with CMV, AMV and CPAP, respectively. Combined PEEP and CMV reduced tidal excursion of segmental diaphragm muscle length; consequently, tidal volume (VT) decreased. VT was maintained with combined PEEP and AMV. CMV alone decreased maximum tetanic force (Po) production by 35% versus control (P < 0.01). Combined PEEP and CMV did not decrease Po further. Po was preserved with AMV, with or without PEEP. Diaphragm muscle atrophy did not occur in any fiber types. Diaphragm MyHC shifted to the fast isoform in the combined PEEP and CMV group. In both the CMV and combined PEEP and CMV groups compared to controls, IGF-1 mRNAs were suppressed, whereas Caspase-3, MAFbx and MuRF1 mRNA expression were elevated. Conclusions Two days of diaphragm muscle fiber shortening with PEEP did not exacerbate CMV-induced diaphragm muscle dysfunction.
Collapse
|
96
|
Smuder AJ, Nelson WB, Hudson MB, Kavazis AN, Powers SK. Inhibition of the ubiquitin-proteasome pathway does not protect against ventilator-induced accelerated proteolysis or atrophy in the diaphragm. Anesthesiology 2014; 121:115-26. [PMID: 24681580 DOI: 10.1097/aln.0000000000000245] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mechanical ventilation (MV) is a life-saving intervention in patients with acute respiratory failure. However, prolonged MV results in ventilator-induced diaphragm dysfunction (VIDD), a condition characterized by both diaphragm fiber atrophy and contractile dysfunction. Previous work has shown that calpain, caspase-3, and the ubiquitin-proteasome pathway (UPP) are all activated in the diaphragm during prolonged MV. However, although it is established that both calpain and caspase-3 are important contributors to VIDD, the role that the UPP plays in the development of VIDD remains unknown. These experiments tested the hypothesis that inhibition of the UPP will protect the diaphragm against VIDD. METHODS The authors tested this prediction in an established animal model of MV using a highly specific UPP inhibitor, epoxomicin, to prevent MV-induced activation of the proteasome in the diaphragm (n = 8 per group). RESULTS The results of this study reveal that inhibition of the UPP did not prevent ventilator-induced diaphragm muscle fiber atrophy and contractile dysfunction during 12 h of MV. Also, inhibition of the UPP does not affect MV-induced increases in calpain and caspase-3 activity in the diaphragm. Finally, administration of the proteasome inhibitor did not protect against the MV-induced increases in the expression of the E3 ligases, muscle ring finger-1 (MuRF1), and atrogin-1/MaFbx. CONCLUSION Collectively, these results indicate that proteasome activation does not play a required role in VIDD development during the first 12 h of MV.
Collapse
Affiliation(s)
- Ashley J Smuder
- From the Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, Florida (A.J.S., S.K.P.); Division of Mathematics, Computer, and Natural Sciences, Department of Natural Sciences, Ohio Dominican University, Columbus, Ohio (W.B.N.); Department of Medicine, Emory University, Atlanta, Georgia (M.B.H.); and School of Kinesiology, Auburn University, Auburn, Alabama (A.N.K.)
| | | | | | | | | |
Collapse
|
97
|
Ichinoseki-Sekine N, Yoshihara T, Kakigi R, Sugiura T, Powers SK, Naito H. Heat stress protects against mechanical ventilation-induced diaphragmatic atrophy. J Appl Physiol (1985) 2014; 117:518-24. [PMID: 25059237 DOI: 10.1152/japplphysiol.00170.2014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mechanical ventilation (MV) is a life-saving intervention in patients who are incapable of maintaining adequate pulmonary gas exchange due to respiratory failure or other disorders. However, prolonged MV is associated with the development of respiratory muscle weakness. We hypothesized that a single exposure to whole body heat stress would increase diaphragm expression of heat shock protein 72 (HSP72) and that this treatment would protect against MV-induced diaphragmatic atrophy. Adult male Wistar rats (n = 38) were randomly assigned to one of four groups: an acutely anesthetized control group (CON) with no MV; 12-h controlled MV group (CMV); 1-h whole body heat stress (HS); or 1-h whole body heat stress 24 h prior to 12-h controlled MV (HSMV). Compared with CON animals, diaphragmatic HSP72 expression increased significantly in the HS and HSMV groups (P < 0.05). Prolonged MV resulted in significant atrophy of type I, type IIa, and type IIx fibers in the costal diaphragm (P < 0.05). Whole body heat stress attenuated this effect. In contrast, heat stress did not protect against MV-induced diaphragm contractile dysfunction. The mechanisms responsible for this heat stress-induced protection remain unclear but may be linked to increased expression of HSP72 in the diaphragm.
Collapse
Affiliation(s)
| | - Toshinori Yoshihara
- School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Ryo Kakigi
- School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takao Sugiura
- Faculty of Education, Yamaguchi University, Yamaguchi, Yamaguchi, Japan; and
| | - Scott K Powers
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida
| | - Hisashi Naito
- School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| |
Collapse
|
98
|
Hooijman PE, Paul MA, Stienen GJM, Beishuizen A, Van Hees HWH, Singhal S, Bashir M, Budak MT, Morgen J, Barsotti RJ, Levine S, Ottenheijm CAC. Unaffected contractility of diaphragm muscle fibers in humans on mechanical ventilation. Am J Physiol Lung Cell Mol Physiol 2014; 307:L460-70. [PMID: 25038190 DOI: 10.1152/ajplung.00076.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Several studies have indicated that diaphragm dysfunction develops in patients on mechanical ventilation (MV). Here, we tested the hypothesis that the contractility of sarcomeres, i.e., the smallest contractile unit in muscle, is affected in humans on MV. To this end, we compared diaphragm muscle fibers of nine brain-dead organ donors (cases) that had been on MV for 26 ± 5 h with diaphragm muscle fibers from nine patients (controls) undergoing surgery for lung cancer that had been on MV for less than 2 h. In each diaphragm specimen we determined 1) muscle fiber cross-sectional area in cryosections by immunohistochemical methods and 2) the contractile performance of permeabilized single muscle fibers by means of maximum specific force, kinetics of cross-bridge cycling by rate of tension redevelopment, myosin heavy chain content and concentration, and calcium sensitivity of force of slow-twitch and fast-twitch muscle fibers. In case subjects, we noted no statistically significant decrease in outcomes compared with controls in slow-twitch or fast-twitch muscle fibers. These observations indicate that 26 h of MV of humans is not invariably associated with changes in the contractile performance of sarcomeres in the diaphragm.
Collapse
Affiliation(s)
| | | | - Ger J M Stienen
- Departments of Physiology, Faculty of Science, Department of Physics and Astronomy, Vrije Universiteit, Amsterdam, The Netherlands
| | - Albertus Beishuizen
- Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Hieronymus W H Van Hees
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Muhammad Bashir
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Murat T Budak
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Jacqueline Morgen
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Robert J Barsotti
- Department of Physiology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Sanford Levine
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Gift of Life Donor Program, Philadelphia, Pennsylvania; and
| | - Coen A C Ottenheijm
- Departments of Physiology, Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
| |
Collapse
|
99
|
Corpeno R, Dworkin B, Cacciani N, Salah H, Bergman HM, Ravara B, Vitadello M, Gorza L, Gustafson AM, Hedström Y, Petersson J, Feng HZ, Jin JP, Iwamoto H, Yagi N, Artemenko K, Bergquist J, Larsson L. Time course analysis of mechanical ventilation-induced diaphragm contractile muscle dysfunction in the rat. J Physiol 2014; 592:3859-80. [PMID: 25015920 DOI: 10.1113/jphysiol.2014.277962] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Controlled mechanical ventilation (CMV) plays a key role in triggering the impaired diaphragm muscle function and the concomitant delayed weaning from the respirator in critically ill intensive care unit (ICU) patients. To date, experimental and clinical studies have primarily focused on early effects on the diaphragm by CMV, or at specific time points. To improve our understanding of the mechanisms underlying the impaired diaphragm muscle function in response to mechanical ventilation, we have performed time-resolved analyses between 6 h and 14 days using an experimental rat ICU model allowing detailed studies of the diaphragm in response to long-term CMV. A rapid and early decline in maximum muscle fibre force and preceding muscle fibre atrophy was observed in the diaphragm in response to CMV, resulting in an 85% reduction in residual diaphragm fibre function after 9-14 days of CMV. A modest loss of contractile proteins was observed and linked to an early activation of the ubiquitin proteasome pathway, myosin:actin ratios were not affected and the transcriptional regulation of myosin isoforms did not show any dramatic changes during the observation period. Furthermore, small angle X-ray diffraction analyses demonstrate that myosin can bind to actin in an ATP-dependent manner even after 9-14 days of exposure to CMV. Thus, quantitative changes in muscle fibre size and contractile proteins are not the dominating factors underlying the dramatic decline in diaphragm muscle function in response to CMV, in contrast to earlier observations in limb muscles. The observed early loss of subsarcolemmal neuronal nitric oxide synthase activity, onset of oxidative stress, intracellular lipid accumulation and post-translational protein modifications strongly argue for significant qualitative changes in contractile proteins causing the severely impaired residual function in diaphragm fibres after long-term mechanical ventilation. For the first time, the present study demonstrates novel changes in the diaphragm structure/function and underlying mechanisms at the gene, protein and cellular levels in response to CMV at a high temporal resolution ranging from 6 h to 14 days.
Collapse
Affiliation(s)
- R Corpeno
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden Department of Physiology and Pharmacology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - B Dworkin
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden Department of Physiology and Pharmacology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - N Cacciani
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden Department of Physiology and Pharmacology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H Salah
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden Department of Physiology and Pharmacology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H-M Bergman
- Department of Chemistry-Biomedical Center, Analytical Chemistry and SciLifeLab, Uppsala University, Sweden
| | - B Ravara
- Department of Biomedical Sciences, University of Padova, Italy
| | - M Vitadello
- Department of Biomedical Sciences, University of Padova, Italy CNR-Institute of Neuroscience, Padova section, Italy
| | - L Gorza
- Department of Biomedical Sciences, University of Padova, Italy
| | - A-M Gustafson
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden
| | - Y Hedström
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden Department of Physiology and Pharmacology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - J Petersson
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden
| | - H-Z Feng
- Department of Physiology, Wayne State University, Detroit, MI, USA
| | - J-P Jin
- Department of Physiology, Wayne State University, Detroit, MI, USA
| | - H Iwamoto
- Japan Synchrotron Radiation Research Institute, Sayo-cho, Sayo-gun, Hyogo, Japan
| | - N Yagi
- Japan Synchrotron Radiation Research Institute, Sayo-cho, Sayo-gun, Hyogo, Japan
| | - K Artemenko
- Department of Chemistry-Biomedical Center, Analytical Chemistry and SciLifeLab, Uppsala University, Sweden
| | - J Bergquist
- Department of Chemistry-Biomedical Center, Analytical Chemistry and SciLifeLab, Uppsala University, Sweden
| | - L Larsson
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Sweden Department of Physiology and Pharmacology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
100
|
Hooijman PE, Beishuizen A, de Waard MC, de Man FS, Vermeijden JW, Steenvoorde P, Bouwman RA, Lommen W, van Hees HWH, Heunks LMA, Dickhoff C, van der Peet DL, Girbes ARJ, Jasper JR, Malik FI, Stienen GJM, Hartemink KJ, Paul MA, Ottenheijm CAC. Diaphragm fiber strength is reduced in critically ill patients and restored by a troponin activator. Am J Respir Crit Care Med 2014; 189:863-5. [PMID: 24684359 DOI: 10.1164/rccm.201312-2260le] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|