Research progress on the impact of diaphragmatic function on clinical outcomes in mechanically ventilated patients and nursing implications

doi:10.3761/j.issn.0254-1769.2025.11.018

Abstract

Abstract:

Dysfunction of the diaphragm is a common problem in mechanically ventilated patients and is closely related to various adverse outcomes. This review summarizes the evaluation methods of diaphragm function，the association between diaphragm dysfunction and adverse clinical outcomes in critically ill mechanically ventilated patients，and the protective effect of diaphragm function on adverse outcomes related to mechanical ventilation. The aim is to provide references for medical staff to optimize evaluation techniques，develop personalized nursing plans，and improve patients’ quality of life and health outcomes.

Key words: Ventilation, Diaphragm Function, Nursing Care, Adverse Outcomes, Review

摘要：

膈肌功能障碍是机械通气患者常出现的问题，与多种不良结局密切相关。该文通过对膈肌功能的评估方式、膈肌功能障碍与机械通气患者临床不良结局的关联、减少机械通气患者膈肌功能对临床不良结局影响的干预策略进行综述，以期为临床护理人员优化评估技术、制订个性化护理方案、提升患者生活质量和改善其健康结局提供参考。

关键词: 机构通气, 膈肌功能, 护理, 不良结局, 综述

CHEN Tianchao, FENG Yueying, LAN Yuanmei, WU Haoqi, LIU Xinyi, BAI Yunfeng, ZHAO Mingxi, LUO Hongbo, LI Zunzhu, WU Xinjuan. Research progress on the impact of diaphragmatic function on clinical outcomes in mechanically ventilated patients and nursing implications[J]. Chinese Journal of Nursing, 2025, 60(11): 1394-1399.

陈天超, 冯悦颖, 兰元梅, 吴昊琪, 柳馨怡, 白云锋, 赵明曦, 罗红波, 李尊柱, 吴欣娟. 机械通气患者膈肌功能对临床结局影响的研究进展及护理启示[J]. 中华护理杂志, 2025, 60(11): 1394-1399.

References 40

[1]	Zhang J, Xie Q, Jiang R, et al. Role of diaphragmatic dysfunc-tion in extubation failure among patients at high risk of reintubation:a prospective cohort study[J]. J Crit Care, 2025, 86:154983.
[2]	Dubé BP, Dres M, Mayaux J, et al. Ultrasound evaluation of dia-phragm function in mechanically ventilated patients:compari-son to phrenic stimulation and prognostic implications[J]. Tho-rax, 2017, 72(9):811-818.
[3]	陈一媛, 林敏, 黄美春, 等. 福建省ICU护士对呼吸机相关性膈肌功能障碍护理知信行的现状调查[J]. 中华护理杂志, 2022, 57(7):841-845. DOI
	Chen YY, Lin M, Huang MC, et al. Study on the status of nurses’ knowledge,attitude,practice toward ventilator-induced diaphragm dysfunction care in intensive care unit of Fujian[J]. Chin J Nurs, 2022, 57(7):841-845.
[4]	陈天超, 冯悦颖, 柳馨怡, 等. 基于Web of Science的膈肌功能障碍文献计量学和可视化分析[J]. 中华急危重症护理杂志, 2024, 5(4):367-373.
	Chen TC, Feng YY, Liu XY, et al. Bibliometric and visual analysis of diaphragm dysfunction based on Web of Science[J]. Chin J Emerg Crit Care Nurs, 2024, 5(4):367-373.
[5]	Umbrello M, Formenti P, Lusardi AC, et al. Oesophageal pres-sure and respiratory muscle ultrasonographic measurements indicate inspiratory effort during pressure support ventilation[J]. Br J Anaesth, 2020, 125(1):e148-e157.
[6]	Scholten AJ, van Leuteren RW, de Jongh FH, et al. Transcu-taneous electromyography as a tool to assess recovery of hemi-diaphragmatic paresis:a case report[J]. J Neonatal Perinatal Med, 2023, 16(4):725-729. DOI PMID
[7]	Deshmukh MP, Baxi G, Wadhokar OC, et al. Determining the optimal position of surface electrodes for diaphragm electrom-yography:a cross-sectional study[J]. Cureus, 2024, 16(2):e55176.
[8]	Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients[J]. Aust Crit Care, 2017, 30(1):37-43. DOI PMID
[9]	Gok F, Mercan A, Kilicaslan A, et al. Diaphragm and lung ul-trasonography during weaning from mechanical ventilation in critically ill patients[J]. Cureus, 2021, 13(5):e15057.
[10]	Zhang P, Jiang HJ, Zhou Q, et al. The predictive value of ul-trasonic measurement of the diaphragmatic thickening fraction combined with the maximal inspiratory pressure in mecha-nical ventilation patients[J]. Dept Critical Care Med, 2020, 43(9):778-783.
[11]	Khurana J, Gartner SC, Naik L, et al. Ultrasound identification of diaphragm by novices using ABCDE technique[J]. Reg Anesth Pain Med, 2018, 43(2):161-165. DOI PMID
[12]	Capdevila M, De Jong A, Belafia F, et al. Ultrasound-guided transcutaneous phrenic nerve stimulation in critically ill patients:a new method to evaluate diaphragmatic function[J]. Anesthesiology, 2025, 142(3):522-531.
[13]	Neagu A, Zah CA, Bucur A, et al. Ultrasound guided phrenic nerve block for percutaneous computer tomography guided lung biopsy[J]. Intern Med, 2024, 21(1):59-64.
[14]	Bachasson D, Dres M, Niérat MC, et al. Diaphragm shear mo-dulus reflects transdiaphragmatic pressure during isovolume-tric inspiratory efforts and ventilation against inspiratory load-ing[J]. J Appl Physiol, 2019, 126(3):699-707. DOI PMID
[15]	Aarab Y, Flatres A, Garnier F, et al. Shear wave elastography,a new tool for diaphragmatic qualitative assessment:a transla-tional study[J]. Am J Respir Crit Care Med, 2021, 204(7):797-806.
[16]	Orde SR, Boon AJ, Firth DG, et al. Diaphragm assessment by two dimensional speckle tracking imaging in normal subjects[J]. BMC Anesthesiol, 2016, 16(1):43. DOI PMID
[17]	Oppersma E, Hatam N, Doorduin J, et al. Functional assess-ment of the diaphragm by speckle tracking ultrasound during inspiratory loading[J]. J Appl Physiol, 2017, 123(5):1063-1070. DOI PMID
[18]	白云锋, 陈天超, 孙建华, 等. 重症患者膈肌功能障碍评估的范围综述[J]. 中华护理杂志, 2023, 58(15):1913-1920. DOI
	Bai YF, Chen TC, Sun JH, et al. Critical illness-related diaph-ragmatic dysfunction assessment:a scoping review[J]. Chin J Nurs, 2023, 58(15):1913-1920.
[19]	Chang YJ, Bae J, Kim N, et al. Three-dimensional quadratic modeling and quantitative evaluation of the diaphragm on a volumetric CT scan in patients with chronic obstructive pul-monary disease[J]. Med Phys, 2016, 43(7):4273.
[20]	Laghi FA Jr, Saad M, Shaikh H. Ultrasound and non-ultra-sound imaging techniques in the assessment of diaphragmatic dysfunction[J]. BMC Pulm Med, 2021, 21(1):85.
[21]	Chen J, Zhong W, Li S. Quantitative evaluation of diaphrag-matic motion during forced breathing in COPD patients[J]. Front Integr Neurosci, 2022, 16:842404.
[22]	Hao Y, Udupa JK, Tong Y, et al. Regional diaphragm motion analysis via dynamic MRI[J]. Proc SPIE Int Soc Opt Eng, 2022, 12031:120313F.
[23]	Islam O, Lin AW, Bharatha A. Potential application of ultra-low field portable MRI in the ICU to improve CT and MRI access in Canadian hospitals:a multi-center retrospective ana-lysis[J]. Front Neurol, 2023, 14:1220091.
[24]	Demoule A, Molinari N, Jung B, et al. Patterns of diaphragm function in critically ill patients receiving prolonged me-chanical ventilation:a prospective longitudinal study[J]. Ann Intensive Care, 2016, 6(1):75.
[25]	Saccheri C, Morawiec E, Delemazure J, et al. ICU-acquired weak-ness,diaphragm dysfunction and long-term outcomes of criti-cally ill patients[J]. Ann Intensive Care, 2020, 10(1):1. DOI PMID
[26]	Hamel RN, Smoliga JM. Physical activity intolerance and car-diorespiratory dysfunction in patients with moderate-to-severe traumatic brain injury[J]. Sports Med, 2019, 49(8):1183-1198.
[27]	黄佳伟, 焦宇倩, 王娴雅, 等. 不同通气模式对妇科腹腔镜手术患者膈肌功能的影响[J]. 临床麻醉学杂志, 2023, 39(11):1125-1130.
	Huang JW, Jiao YQ, Wang XY, et al. Effects of different ven-tilation modes on diaphragm function in patients undergoing laparoscopic gynecological surgery[J]. J Clin Anesthesiol, 2023, 39(11):1125-1130.
[28]	Demoule A, Jung B, Prodanovic H, et al. Diaphragm dysfunc-tion on admission to the intensive care unit. Prevalence,risk factors,and prognostic impact:a prospective study[J]. Am J Re-spir Crit Care Med, 2013, 188(2):213-219.
[29]	Huang DZ, Ma H, Zhong WZ, et al. Using M-mode ultrasono-graphy to assess diaphragm dysfunction and predict the success of mechanical ventilation weaning in elderly patients[J]. J Thorac Dis, 2017, 9(9):3177-3186.
[30]	Omara ISM, Nagi HK, El Aziz Mohamed KA, et al. Periope-rative assessment of diaphragmatic dysfunction in cardiac surgery patients and its effect on outcome:a prospective ob-servational study[J]. Anaesth Pain Intensive Care, 2024, 28(5):816-823.
[31]	Menis AA, Tsolaki V, Papadonta ME, et al. The relationship of diaphragmatic ultrasound-based and manometric indices with difficult weaning in tracheostomized patients[J]. Respir Care, 2024, 69(10):1323-1331.
[32]	Chung E, Leem AY, Lee SH, et al. Predicting successful wean-ing through sonographic measurement of the rapid shallow breathing index[J]. J Clin Med, 2024, 13(16):4809.
[33]	Cavayas YA, Eljaiek R, Rodrigue é, et al. Preoperative diaph-ragm function is associated with postoperative pulmonary complications after cardiac surgery[J]. Crit Care Med, 2019, 47(12):e966-e974.
[34]	Lincoln U UCM, Sahar W, Elengoe A, et al. Impact of preope-rative diaphragmatic breathing exercise on postoperative oxy-genation and hospital length of stay in patients with elective coronary artery bypass graft:a narrative review[J]. T Rehabili J, 2024, 8(3):44-52.
[35]	Goligher EC, Brochard LJ, Darlene Reid W, et al. Diaphragma-tic myotrauma:a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure[J]. Lancet Respir Med, 2019, 7(1):90-98. DOI PMID
[36]	de Vries HJ, Jonkman AH, de Grooth HJ, et al. Lung- and dia-phragm-protective ventilation by titrating inspiratory support to diaphragm effort:a randomized clinical trial[J]. Crit Care Med, 2022, 50(2):192-203.
[37]	Wu Y, Wang SQ, Zhang J, et al. Effects of diaphragm elec-trical stimulation in treating respiratory dysfunction on mechanical ventilation after intracerebral hemorrhage:a single-center retrospective study[J]. Medicine, 2024, 103(1):e36767.
[38]	刘秀, 刘滨滨, 权明桃, 等. ICU机械通气患者膈肌锻炼方案的构建及应用研究[J]. 中华护理杂志, 2023, 58(3):261-267. DOI
	Liu X, Liu BB, Quan MT, et al. Construction and application of a diaphragm exercise program in patients with mechanical ventilation in ICU[J]. Chin J Nurs, 2023, 58(3):261-267. DOI
[39]	Chen XY, Hou L, Zhang YY, et al. The effects of five days of intensive preoperative inspiratory muscle training on posto-perative complications and outcome in patients having cardiac surgery:a randomized controlled trial[J]. Clin Rehabil, 2019, 33(5):913-922.
[40]	Waterland JL, McCourt O, Edbrooke L, et al. Efficacy of pre-habilitation including exercise on postoperative outcomes following abdominal cancer surgery:a systematic review and meta-analysis[J]. Front Surg, 2021, 8:628848.