ArticleAmerican journal of respiratory and critical care medicine2018
Positive End-Expiratory Pressure Ventilation Induces Longitudinal Atrophy in Diaphragm Fibers.
Article in American journal of respiratory and critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
57 citing papers in PubMed, 2 syntheses or guidelines pooled it, 108 citations in OpenAlex.
- Physiological effects of noninvasive respiratory support strategies in adults with acute hypoxemic respiratory failure: a systematic review and network meta-analysis.Critical care (London, England) · 2025Pooled it
- Effect of noninvasive respiratory support on interstitial lung disease with acute respiratory failure: A systematic review and meta-analysis.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2023Pooled it
- Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial.Intensive care medicine · 2024Trial
- Effect of Individualized PEEP Guided by Driving Pressure on Diaphragm Function in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer: A Randomized Controlled Trial.Medical science monitor : international medical journal of experimental and clinical research · 2024Trial
- Effects of elevated positive end-expiratory pressure on diaphragmatic blood flow and vascular resistance during mechanical ventilation.Journal of applied physiology (Bethesda, Md. : 1985) · 2020Trial
- Lung- and diaphragm-protective mechanical ventilation in acute respiratory distress syndrome.Intensive care medicine · 2026Review
- The titin N2A-MARP signalosome constrains muscle longitudinal hypertrophy in response to stretch.eLife · 2026Article
- Targeting the diaphragm during weaning from mechanical ventilation.Journal of thoracic disease · 2026Article
- Species-specific effects of positive end-expiratory pressure on diaphragm and chest wall geometry in mice, rats, and humans.American journal of physiology. Regulatory, integrative and comparative physiology · 2026Article
- The contribution of mechanical ventilation to critical illness-associated diaphragm dysfunction: a critical appraisal.Critical care (London, England) · 2026Review
- CPAP and high-flow nasal oxygen also reduce lung, diaphragm, and accessory muscle injury in experimental self-inflicted lung injury.Scientific reports · 2026Article
- Loss of Myonuclei and Transcriptional Activity During Diaphragm Atrophy in Critically Ill Patients.Journal of cachexia, sarcopenia and muscle · 2026Article
- Ventilator Settings and Monitoring Variables Associated with Extubation Failure in Critically Ill Patients: A Retrospective Cohort Study.Critical care science · 2026Observational
- Role of spontaneous ventilation in diaphragm protection during invasive mechanical ventilation in patients with acute respiratory distress syndrome: a prospective observational study.Critical care science · 2026Observational
- High PEEP Activates ITGB1, Inducing Diaphragm Fibrosis During Prolonged Mechanical Ventilation.Biomolecules · 2025Article
- Ventilator-induced diaphragmatic dysfunction: pathophysiology, monitoring and advances in potential treatment and prevention.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Assessing inspiratory drive and effort in critically ill patients at the bedside.Critical care (London, England) · 2025Review
- Diaphragm Function in Very Preterm Infants at 36 Weeks' Postmenstrual Age.Pediatric pulmonology · 2025Observational
- Debate on the Role of Eccentric Contraction of the Diaphragm: Is It Always Harmful?Healthcare (Basel, Switzerland) · 2025Article
- Challenges in Transitioning from Controlled to Assisted Ventilation in Acute Respiratory Distress Syndrome (ARDS) Management.Journal of clinical medicine · 2024Article
Corrections and comments
- Commented on by
Authors and funding
20 authors at 5 institutions in 3 countries.
Funding
Abstract
rationaleDiaphragm weakness in critically ill patients prolongs ventilator dependency and duration of hospital stay and increases mortality and healthcare costs. The mechanisms underlying diaphragm weakness include cross-sectional fiber atrophy and contractile protein dysfunction, but whether additional mechanisms are at play is unknown.
objectivesTo test the hypothesis that mechanical ventilation with positive end-expiratory pressure (PEEP) induces longitudinal atrophy by displacing the diaphragm in the caudal direction and reducing the length of fibers.
methodsWe studied structure and function of diaphragm fibers of mechanically ventilated critically ill patients and mechanically ventilated rats with normal and increased titin compliance. MEASUREMENTS AND MAIN
resultsPEEP causes a caudal movement of the diaphragm, both in critically ill patients and in rats, and this caudal movement reduces fiber length. Diaphragm fibers of 18-hour mechanically ventilated rats (PEEP of 2.5 cm H
conclusionsMechanical ventilation with PEEP results in longitudinal atrophy of diaphragm fibers, a response that is modulated by the elasticity of the giant sarcomeric protein titin. We postulate that longitudinal atrophy, in concert with the aforementioned cross-sectional atrophy, hampers spontaneous breathing trials in critically ill patients: during these efforts, end-expiratory lung volume is reduced, and the shortened diaphragm fibers are stretched to excessive sarcomere lengths. At these lengths, muscle fibers generate less force, and diaphragm weakness ensues.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.