{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:41:00Z","timestamp":1793320860062,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2013,7,1]],"date-time":"2013-07-01T00:00:00Z","timestamp":1372636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Diaphragmatic insults occurring during intensive care unit (ICU) stays have become the focus of intense research. However, diaphragmatic abnormalities at the initial phase of critical illness remain poorly documented in humans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the incidence, risk factors, and prognostic impact of diaphragmatic impairment on ICU admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective, 6-month, observational cohort study in two ICUs. Mechanically ventilated patients were studied within 24 hours after intubation (Day 1) and 48 hours later (Day 3). Seventeen anesthetized intubated control anesthesia patients were also studied. The diaphragm was assessed by twitch tracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Eighty-five consecutive patients aged 62 (54\u201375) (median [interquartile range]) were evaluated (medical admission, 79%; Simplified Acute Physiology Score II, 54 [44\u201368]). On Day 1, Ptr,stim was 8.2 (5.9\u201312.3) cm H2O and 64% of patients had Ptr,stim less than 11 cm H2O. Independent predictors of low Ptr,stim were sepsis (linear regression coefficient, \u22123.74; standard error, 1.16; P = 0.002) and Simplified Acute Physiology Score II (linear regression coefficient, \u22120.07; standard error, 1.69; P = 0.03). Compared with nonsurvivors, ICU survivors had higher Ptr,stim (9.7 [6.3\u201313.8] vs. 7.3 [5.5\u20139.7] cm H2O; P = 0.004). This was also true for hospital survivors versus nonsurvivors (9.7 [6.3\u201313.5] vs. 7.8 [5.5\u201310.1] cm H2O; P = 0.004). Day 1 and Day 3 Ptr,stim were similar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A reduced capacity of the diaphragm to produce inspiratory pressure (diaphragm dysfunction) is frequent on ICU admission. It is associated with sepsis and disease severity, suggesting that it may represent another form of organ failure. It is associated with a poor prognosis.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT 00786526).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201209-1668oc","type":"journal-article","created":{"date-parts":[[2013,5,3]],"date-time":"2013-05-03T17:28:07Z","timestamp":1367602087000},"page":"213-219","source":"Crossref","is-referenced-by-count":395,"title":["Diaphragm Dysfunction on Admission to the Intensive Care Unit. Prevalence, Risk Factors, and Prognostic Impact\u2014A Prospective Study"],"prefix":"10.1093","volume":"188","author":[{"given":"Alexandre","family":"Demoule","sequence":"first","affiliation":[{"name":"University Paris 6\u2013Pierre et Marie Curie, ER10, Paris, France"},{"name":"Assistance Publique\u2013H\u00f4pitaux de Paris, Department of Respiratory and Intensive Care Medicine, Groupe Hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France"},{"name":"U974, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Jung","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France"},{"name":"INSERM U-1046, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, University Montpellier I, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9l\u00e8ne","family":"Prodanovic","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2013H\u00f4pitaux de Paris, Department of Respiratory and Intensive Care Medicine, Groupe Hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Molinari","sequence":"additional","affiliation":[{"name":"Department of Medical Information, H\u00f4pital Arnaud de Villeneuve and University of Montpellier, Montpellier, France; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Chanques","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France"},{"name":"INSERM U-1046, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, University Montpellier I, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Coirault","sequence":"additional","affiliation":[{"name":"U974, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Matecki","sequence":"additional","affiliation":[{"name":"INSERM U-1046, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, University Montpellier I, Montpellier, France"},{"name":"Department of Clinical Physiology, H\u00f4pital Arnaud de Villeneuve, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Duguet","sequence":"additional","affiliation":[{"name":"University Paris 6\u2013Pierre et Marie Curie, ER10, Paris, France"},{"name":"Assistance Publique\u2013H\u00f4pitaux de Paris, Department of Respiratory and Intensive Care Medicine, Groupe Hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Similowski","sequence":"additional","affiliation":[{"name":"University Paris 6\u2013Pierre et Marie Curie, ER10, Paris, France"},{"name":"Assistance Publique\u2013H\u00f4pitaux de Paris, Department of Respiratory and Intensive Care Medicine, Groupe Hospitalier Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Jaber","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department, Saint Eloi Hospital, Montpellier, France"},{"name":"INSERM U-1046, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, University Montpellier I, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2013,7,15]]},"reference":[{"key":"2026032100501121200_bib1","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1097\/CCM.0b013e3182266408","article-title":"Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation","volume":"39","author":"Kim","year":"2011","journal-title":"Crit Care Med"},{"key":"2026032100501121200_bib2","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1097\/01.ccm.0000281450.01881.d8","article-title":"Respiratory weakness is associated with limb weakness and delayed weaning in critical illness","volume":"35","author":"De Jonghe","year":"2007","journal-title":"Crit Care Med"},{"key":"2026032100501121200_bib3","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1056\/NEJMoa070447","article-title":"Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans","volume":"358","author":"Levine","year":"2008","journal-title":"N Engl J Med"},{"key":"2026032100501121200_bib4","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1164\/rccm.201004-0670OC","article-title":"Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans","volume":"183","author":"Jaber","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032100501121200_bib5","doi-asserted-by":"crossref","first-page":"R127","DOI":"10.1186\/cc9094","article-title":"Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study","volume":"14","author":"Hermans","year":"2010","journal-title":"Crit Care"},{"key":"2026032100501121200_bib6","first-page":"19","article-title":"Ventilator-induced diaphragmatic dysfunction","volume":"16","author":"Petrof","year":"2010","journal-title":"Curr Opin Crit Care"},{"key":"2026032100501121200_bib7","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1152\/jappl.1995.78.2.629","article-title":"Corticosteroid treatment and nutritional deprivation cause a different pattern of atrophy in rat diaphragm","volume":"78","author":"Dekhuijzen","year":"1995","journal-title":"J Appl Physiol"},{"key":"2026032100501121200_bib8","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1097\/CCM.0b013e318174db05","article-title":"Actual incidence of global left ventricular hypokinesia in adult septic shock","volume":"36","author":"Vieillard-Baron","year":"2008","journal-title":"Crit Care Med"},{"key":"2026032100501121200_bib9","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1212\/01.wnl.0000239826.63523.8e","article-title":"Early development of critical illness myopathy and neuropathy in patients with severe sepsis","volume":"67","author":"Khan","year":"2006","journal-title":"Neurology"},{"key":"2026032100501121200_bib10","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0140-6736(02)09459-X","article-title":"Association between mitochondrial dysfunction and severity and outcome of septic shock","volume":"360","author":"Brealey","year":"2002","journal-title":"Lancet"},{"key":"2026032100501121200_bib11","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1152\/jappl.1981.51.2.499","article-title":"Respiratory muscle fatigue during cardiogenic shock","volume":"51","author":"Aubier","year":"1981","journal-title":"J Appl Physiol"},{"key":"2026032100501121200_bib12","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1152\/jappl.1984.56.3.648","article-title":"Function of canine diaphragm with hypovolemic shock and beta-adrenergic blockade","volume":"56","author":"Scharf","year":"1984","journal-title":"J Appl Physiol"},{"key":"2026032100501121200_bib13","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1152\/jappl.1985.59.6.1802","article-title":"Distribution of respiratory muscle and organ blood flow during endotoxic shock in dogs","volume":"59","author":"Hussain","year":"1985","journal-title":"J Appl Physiol"},{"key":"2026032100501121200_bib14","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1164\/rccm.200509-1511OC","article-title":"Endotoxin triggers nuclear factor-kappab-dependent up-regulation of multiple proinflammatory genes in the diaphragm","volume":"174","author":"Demoule","year":"2006","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032100501121200_bib15","first-page":"S187","article-title":"Evidence for sepsis-induced diaphragm dysfunction in critically-ill patients [abstract]","volume":"37","author":"Demoule","year":"2011","journal-title":"Intensive Care Med"},{"key":"2026032100501121200_bib16","first-page":"A2701","article-title":"Incidence, risk factors and prognosis impact of diaphragm dysfunction on ICU admission [abstract]","volume":"185","author":"Demoule","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032100501121200_bib17","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1164\/ajrccm.154.4.8887614","article-title":"Bilateral magnetic stimulation of the phrenic nerves from an anterolateral approach","volume":"154","author":"Mills","year":"1996","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032100501121200_bib18","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1097\/01.CCM.0000050454.01978.3B","article-title":"2001 SCCM\/ESICM\/ACCP\/ATS\/SIS International Sepsis Definitions Conference","volume":"31","author":"Levy","year":"2003","journal-title":"Crit Care Med"},{"key":"2026032100501121200_bib19","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1164\/rccm.166.4.518","article-title":"ATS\/ERS statement on respiratory muscle testing","volume":"166","author":"American Thoracic Society\/European Respiratory Society","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032100501121200_bib20","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1136\/thx.51.12.1239","article-title":"Clinical assessment of diaphragm strength by cervical magnetic stimulation of the phrenic nerves","volume":"51","author":"Hamnegard","year":"1996","journal-title":"Thorax"},{"key":"2026032100501121200_bib21","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/01.CCM.0000114827.93410.D8","article-title":"Brain natriuretic peptide: a marker of myocardial dysfunction and prognosis during severe sepsis","volume":"32","author":"Charpentier","year":"2004","journal-title":"Crit Care Med"},{"key":"2026032100501121200_bib22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/bja\/aep339","article-title":"Sepsis and the heart","volume":"104","author":"Hunter","year":"2010","journal-title":"Br J Anaesth"},{"key":"2026032100501121200_bib23","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1378\/chest.112.2.472","article-title":"The effect of sepsis on breathing pattern and weaning outcomes in patients recovering from respiratory failure","volume":"112","author":"Amoateng-Adjepong","year":"1997","journal-title":"Chest"},{"key":"2026032100501121200_bib24","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1001\/jama.1996.03540100046027","article-title":"The logistic organ dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU scoring group","volume":"276","author":"Le Gall","year":"1996","journal-title":"JAMA"},{"key":"2026032100501121200_bib25","doi-asserted-by":"crossref","first-page":"2957","DOI":"10.1001\/jama.1993.03510240069035","article-title":"A new Simplified Acute Physiology Score (SAPS II) based on a European\/North American multicenter study","volume":"270","author":"Le Gall","year":"1993","journal-title":"JAMA"},{"key":"2026032100501121200_bib26","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1007\/s00134-004-2174-z","article-title":"Does ICU-acquired paresis lengthen weaning from mechanical ventilation?","volume":"30","author":"De Jonghe","year":"2004","journal-title":"Intensive Care Med"},{"key":"2026032100501121200_bib27","doi-asserted-by":"crossref","first-page":"2859","DOI":"10.1001\/jama.288.22.2859","article-title":"Paresis acquired in the intensive care unit: a prospective multicenter study","volume":"288","author":"De Jonghe","year":"2002","journal-title":"JAMA"},{"key":"2026032100501121200_bib28","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1097\/00003246-200107000-00005","article-title":"Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit","volume":"29","author":"Watson","year":"2001","journal-title":"Crit Care Med"},{"key":"2026032100501121200_bib29","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1093\/bja\/87.6.876","article-title":"Tracheal tube pressure change during magnetic stimulation of the phrenic nerves as an indicator of diaphragm strength on the intensive care unit","volume":"87","author":"Mills","year":"2001","journal-title":"Br J Anaesth"},{"key":"2026032100501121200_bib30","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1136\/thorax.58.1.58","article-title":"Can diaphragmatic contractility be assessed by airway twitch pressure in mechanically ventilated patients?","volume":"58","author":"Cattapan","year":"2003","journal-title":"Thorax"},{"key":"2026032100501121200_bib31","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1177\/0310057X0503300410","article-title":"Assessment of diaphragmatic function with cervical magnetic stimulation in critically ill patients","volume":"33","author":"Buscher","year":"2005","journal-title":"Anaesth Intensive Care"},{"key":"2026032100501121200_bib32","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1056\/NEJM199109263251304","article-title":"Contractile properties of the human diaphragm during chronic hyperinflation","volume":"325","author":"Similowski","year":"1991","journal-title":"N Engl J Med"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/188\/2\/213\/67241370\/ajrccm_188_2_213.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/188\/2\/213\/67241370\/ajrccm_188_2_213.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T04:52:21Z","timestamp":1774068741000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/188\/2\/213\/8506988"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2013,7,15]]},"published-print":{"date-parts":[[2013,7,15]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.201209-1668oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2013,7]]},"published":{"date-parts":[[2013,7]]}}}