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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 \u2018ventilator\u2010induced diaphragmatic dysfunction\u2019 (VIDD) and should be distinguished from peripheral muscular weakness as observed in \u2018ICU\u2010acquired weakness (ICU\u2010AW)\u2019.<\/jats:p>\n                  <jats:p>Interestingly, VIDD and ICU\u2010AW 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\u2010sectional 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.<\/jats:p>","DOI":"10.1002\/jcsm.12108","type":"journal-article","created":{"date-parts":[[2016,3,12]],"date-time":"2016-03-12T02:04:20Z","timestamp":1457748260000},"page":"403-412","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":99,"title":["Dysfunction of respiratory muscles in critically ill patients on the intensive care unit"],"prefix":"10.1002","volume":"7","author":[{"given":"David","family":"Berger","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Inselspital University Hospital of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Bloechlinger","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Inselspital University Hospital of Bern  Bern Switzerland"},{"name":"Department of Clinical Cardiology, 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