{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T20:35:11Z","timestamp":1793738111341,"version":"4.6.1"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"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":[[2018,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Diaphragm dysfunction worsens outcomes in mechanically ventilated patients, but the clinical impact of potentially preventable changes in diaphragm structure and function caused by mechanical ventilation is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine whether diaphragm atrophy developing during mechanical ventilation leads to prolonged ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Diaphragm thickness was measured daily by ultrasound in adults requiring invasive mechanical ventilation; inspiratory effort was assessed by thickening fraction. The primary outcome was time to liberation from ventilation. Secondary outcomes included complications (reintubation, tracheostomy, prolonged ventilation, or death). Associations were adjusted for age, severity of illness, sepsis, sedation, neuromuscular blockade, and comorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Of 211 patients enrolled, 191 had two or more diaphragm thickness measurements. Thickness decreased more than 10% in 78 patients (41%) by median Day 4 (interquartile range, 3\u20135). Development of decreased thickness was associated with a lower daily probability of liberation from ventilation (adjusted hazard ratio, 0.69; 95% confidence interval [CI], 0.54\u20130.87; per 10% decrease), prolonged ICU admission (adjusted duration ratio, 1.71; 95% CI, 1.29\u20132.27), and a higher risk of complications (adjusted odds ratio, 3.00; 95% CI, 1.34\u20136.72). Development of increased thickness (n\u2009=\u200947; 24%) also predicted prolonged ventilation (adjusted duration ratio, 1.38; 95% CI, 1.00\u20131.90). Decreasing thickness was related to abnormally low inspiratory effort; increasing thickness was related to excessive effort. Patients with thickening fraction between 15% and 30% (similar to breathing at rest) during the first 3 days had the shortest duration of ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diaphragm atrophy developing during mechanical ventilation strongly impacts clinical outcomes. Targeting an inspiratory effort level similar to that of healthy subjects at rest might accelerate liberation from ventilation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201703-0536oc","type":"journal-article","created":{"date-parts":[[2017,9,20]],"date-time":"2017-09-20T16:26:32Z","timestamp":1505924792000},"page":"204-213","source":"Crossref","is-referenced-by-count":698,"title":["Mechanical Ventilation\u2013induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes"],"prefix":"10.1093","volume":"197","author":[{"given":"Ewan C.","family":"Goligher","sequence":"first","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"},{"name":"Department of Physiology"},{"name":"Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Dres","sequence":"additional","affiliation":[{"name":"Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Canada"},{"name":"Respiratory and Critical Care Department, Groupe Hospitalier Piti\u00e9 Salp\u00eatri\u00e8re Charles Foix, Assistance Publique H\u00f4pitaux de Paris, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddy","family":"Fan","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"},{"name":"Department of Medicine"},{"name":"Institute for Health Policy, Management, and Evaluation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon D.","family":"Rubenfeld","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Department of Medicine"},{"name":"Institute for Health Policy, Management, and Evaluation"},{"name":"Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damon C.","family":"Scales","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Department of Medicine"},{"name":"Institute for Health Policy, Management, and Evaluation"},{"name":"Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret S.","family":"Herridge","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"},{"name":"Department of Medicine"},{"name":"Toronto General Research Institute, Toronto, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefannie","family":"Vorona","sequence":"additional","affiliation":[{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Sklar","sequence":"additional","affiliation":[{"name":"Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Canada"},{"name":"Department of Anesthesia, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuttapol","family":"Rittayamai","sequence":"additional","affiliation":[{"name":"Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Lanys","sequence":"additional","affiliation":[{"name":"Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair","family":"Murray","sequence":"additional","affiliation":[{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Brace","sequence":"additional","affiliation":[{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Urrea","sequence":"additional","affiliation":[{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Darlene","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur S.","family":"Slutsky","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Department of Medicine"},{"name":"Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Department of Physiology"},{"name":"Department of Anesthesia, and"},{"name":"Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent J.","family":"Brochard","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Department of Medicine"},{"name":"Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niall D.","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada"},{"name":"Department of Physiology"},{"name":"Department of Medicine"},{"name":"Institute for Health Policy, Management, and Evaluation"},{"name":"Toronto General Research Institute, Toronto, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,1,15]]},"reference":[{"key":"2026032023141373800_bib1","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/S0140-6736(10)60446-1","article-title":"Critical care and the global burden of critical illness in adults","volume":"376","author":"Adhikari","year":"2010","journal-title":"Lancet"},{"key":"2026032023141373800_bib2","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1164\/rccm.201602-0320OC","article-title":"Epidemiology of weaning outcome according to a new definition: the WIND Study","volume":"195","author":"B\u00e9duneau","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib3","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/S2213-2600(15)00150-2","article-title":"Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis","volume":"3","author":"Damuth","year":"2015","journal-title":"Lancet Respir Med"},{"key":"2026032023141373800_bib4","doi-asserted-by":"crossref","first-page":"167","DOI":"10.7326\/0003-4819-153-3-201008030-00007","article-title":"One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study","volume":"153","author":"Unroe","year":"2010","journal-title":"Ann Intern Med"},{"key":"2026032023141373800_bib5","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1164\/rccm.201512-2343OC","article-title":"The RECOVER Program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation","volume":"194","author":"Herridge","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib6","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1097\/CCM.0000000000000710","article-title":"The epidemiology of chronic critical illness in the United States","volume":"43","author":"Kahn","year":"2015","journal-title":"Crit Care Med"},{"key":"2026032023141373800_bib7","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1164\/rccm.201602-0367OC","article-title":"Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients","volume":"195","author":"Dres","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib8","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":"2026032023141373800_bib9","first-page":"811","article-title":"Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications","volume-title":"Thorax","author":"Dub\u00e9","year":"2017"},{"key":"2026032023141373800_bib10","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1164\/rccm.201209-1668OC","article-title":"Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study","volume":"188","author":"Demoule","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib11","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1152\/japplphysiol.00881.2001","article-title":"Mechanical ventilation results in progressive contractile dysfunction in the diaphragm","volume":"92","author":"Powers","year":"2002","journal-title":"J Appl Physiol (1985)"},{"key":"2026032023141373800_bib12","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1152\/japplphysiol.01213.2001","article-title":"Altered diaphragm contractile properties with controlled mechanical ventilation","volume":"92","author":"Sassoon","year":"2002","journal-title":"J Appl Physiol (1985)"},{"key":"2026032023141373800_bib13","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":"2026032023141373800_bib14","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":"2026032023141373800_bib15","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1164\/rccm.200202-088OC","article-title":"l. Mechanical ventilation-induced diaphragmatic atrophy is associated with oxidative injury and increased proteolytic activity","volume":"166","author":"Shanely","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib16","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1164\/rccm.201503-0620OC","article-title":"Evolution of diaphragm thickness during mechanical ventilation. impact of inspiratory effort","volume":"192","author":"Goligher","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib17","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1097\/ALN.0b013e3181d7b036","article-title":"Adaptive support ventilation prevents ventilator-induced diaphragmatic dysfunction in piglet: an in vivo and in vitro study","volume":"112","author":"Jung","year":"2010","journal-title":"Anesthesiology"},{"key":"2026032023141373800_bib18","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1164\/ajrccm.164.9.2011150","article-title":"Injury of the human diaphragm associated with exertion and chronic obstructive pulmonary disease","volume":"164","author":"Orozco-Levi","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib19","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1164\/rccm.201508-1700LE","article-title":"Controlled mechanical ventilation attenuates the systemic inflammation of severe chronic obstructive pulmonary disease exacerbations","volume":"193","author":"Hillas","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib20","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1164\/ajrccm.165.2.2108041","article-title":"Mechanical ventilation protects against diaphragm injury in sepsis: interaction of oxidative and mechanical stresses","volume":"165","author":"Ebihara","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib21","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13613-016-0179-8","article-title":"Patterns of diaphragm function in critically ill patients receiving prolonged mechanical ventilation: a prospective longitudinal study","volume":"6","author":"Demoule","year":"2016","journal-title":"Ann Intensive Care"},{"key":"2026032023141373800_bib22","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s00134-015-4125-2","article-title":"Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure","volume":"42","author":"Jung","year":"2016","journal-title":"Intensive Care Med"},{"key":"2026032023141373800_bib23","doi-asserted-by":"crossref","first-page":"904","DOI":"10.4187\/respcare.05370","article-title":"Diaphragm muscle thinning in subjects receiving mechanical ventilation and its effect on extubation","volume":"62","author":"Grosu","year":"2017","journal-title":"Respir Care"},{"key":"2026032023141373800_bib24","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00134-016-4524-z","article-title":"Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review","volume":"43","author":"Zambon","year":"2017","journal-title":"Intensive Care Med"},{"key":"2026032023141373800_bib25","first-page":"30","article-title":"Are changes in diaphragm thickness during mechanical ventilation associated with clinical outcomes? A prospective multi-centre cohort study","volume":"4","author":"Goligher","year":"2016","journal-title":"Intensive Care Med Exp"},{"key":"2026032023141373800_bib26","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"},{"key":"2026032023141373800_bib27","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1007\/s00134-015-3687-3","article-title":"Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity","volume":"41","author":"Goligher","year":"2015","journal-title":"Intensive Care Med"},{"key":"2026032023141373800_bib28","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/2036-7902-6-8","article-title":"Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation","volume":"6","author":"Ferrari","year":"2014","journal-title":"Crit Ultrasound J"},{"key":"2026032023141373800_bib29","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1002\/mus.23702","article-title":"Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects","volume":"47","author":"Boon","year":"2013","journal-title":"Muscle Nerve"},{"key":"2026032023141373800_bib30","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":"2026032023141373800_bib31","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"2026032023141373800_bib32","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1097\/00003246-199907000-00022","article-title":"Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients","volume":"27","author":"Riker","year":"1999","journal-title":"Crit Care Med"},{"key":"2026032023141373800_bib33","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med"},{"key":"2026032023141373800_bib34","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1056\/NEJM199612193352502","article-title":"Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously","volume":"335","author":"Ely","year":"1996","journal-title":"N Engl J Med"},{"key":"2026032023141373800_bib35","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1001\/jama.2013.278481","article-title":"Acute skeletal muscle wasting in critical illness","volume":"310","author":"Puthucheary","year":"2013","journal-title":"JAMA"},{"key":"2026032023141373800_bib36","first-page":"295","article-title":"The environment and disease: association or causation?","volume":"58","author":"Hill","year":"1965","journal-title":"Proc R Soc Med"},{"key":"2026032023141373800_bib37","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1164\/rccm.201502-0363OC","article-title":"Mitigation of ventilator-induced diaphragm atrophy by transvenous phrenic nerve stimulation","volume":"195","author":"Reynolds","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib38","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1164\/rccm.201412-2214OC","article-title":"Diaphragm muscle fiber weakness and ubiquitin-proteasome activation in critically ill patients","volume":"191","author":"Hooijman","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib39","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1097\/ALN.0000000000000201","article-title":"Sepsis is associated with a preferential diaphragmatic atrophy: a critically ill patient study using tridimensional computed tomography","volume":"120","author":"Jung","year":"2014","journal-title":"Anesthesiology"},{"key":"2026032023141373800_bib40","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1378\/chest.11-1638","article-title":"Diaphragm muscle thinning in patients who are mechanically ventilated","volume":"142","author":"Grosu","year":"2012","journal-title":"Chest"},{"key":"2026032023141373800_bib41","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1186\/s13054-015-1141-0","article-title":"The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study","volume":"19","author":"Schepens","year":"2015","journal-title":"Crit Care"},{"key":"2026032023141373800_bib42","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1097\/CCM.0000000000001657","article-title":"Mechanical ventilation and diaphragmatic atrophy in critically ill patients: an ultrasound study","volume":"44","author":"Zambon","year":"2016","journal-title":"Crit Care Med"},{"key":"2026032023141373800_bib43","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s00421-014-3073-9","article-title":"Effect of low-load resistance exercise with and without blood flow restriction to volitional fatigue on muscle swelling","volume":"115","author":"Yasuda","year":"2015","journal-title":"Eur J Appl Physiol"},{"key":"2026032023141373800_bib44","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1164\/rccm.201303-0539OC","article-title":"Spontaneous effort causes occult pendelluft during mechanical ventilation","volume":"188","author":"Yoshida","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib45","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1186\/s13054-015-0894-9","article-title":"Diaphragm ultrasound as indicator of respiratory effort in critically ill patients undergoing assisted mechanical ventilation: a pilot clinical study","volume":"19","author":"Umbrello","year":"2015","journal-title":"Crit Care"},{"key":"2026032023141373800_bib46","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s00134-012-2547-7","article-title":"Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation","volume":"38","author":"Vivier","year":"2012","journal-title":"Intensive Care Med"},{"key":"2026032023141373800_bib47","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1164\/ajrccm.164.3.2009018","article-title":"Electrical activity of the diaphragm during pressure support ventilation in acute respiratory failure","volume":"164","author":"Beck","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib48","doi-asserted-by":"crossref","first-page":"2146","DOI":"10.1152\/jappl.1998.85.6.2146","article-title":"Voluntary activation of the human diaphragm in health and disease","volume":"85","author":"Sinderby","year":"1998","journal-title":"J Appl Physiol (1985)"},{"key":"2026032023141373800_bib49","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1152\/jappl.1986.60.2.486","article-title":"Respiratory muscle energetics during endotoxic shock in dogs","volume":"60","author":"Hussain","year":"1986","journal-title":"J Appl Physiol (1985)"},{"key":"2026032023141373800_bib50","doi-asserted-by":"crossref","first-page":"927","DOI":"10.2519\/jospt.2013.4931","article-title":"Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound","volume":"43","author":"Harper","year":"2013","journal-title":"J Orthop Sports Phys Ther"},{"key":"2026032023141373800_bib51","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1056\/NEJMoa032736","article-title":"Noninvasive positive-pressure ventilation for respiratory failure after extubation","volume":"350","author":"Esteban","year":"2004","journal-title":"N Engl J Med"},{"key":"2026032023141373800_bib52","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1164\/rccm.201208-1523CI","article-title":"The decision to extubate in the intensive care unit","volume":"187","author":"Thille","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023141373800_bib53","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1136\/thoraxjnl-2013-204111","article-title":"Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation","volume":"69","author":"DiNino","year":"2014","journal-title":"Thorax"},{"key":"2026032023141373800_bib54","first-page":"1122","article-title":"Core outcome measures for clinical research in acute respiratory failure survivors: an international modified Delphi consensus study","volume-title":"Am J Respir Crit Care Med","author":"Needham","year":"2017"},{"key":"2026032023141373800_bib55","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1164\/rccm.201401-0158OC","article-title":"Risk factors for physical impairment after acute lung injury in a national, multicenter study","volume":"189","author":"Needham","year":"2014","journal-title":"Am J Respir Crit Care Med"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/197\/2\/204\/67121572\/ajrccm_197_2_204.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/197\/2\/204\/67121572\/ajrccm_197_2_204.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T03:14:30Z","timestamp":1774062870000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/197\/2\/204\/8498490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1]]},"references-count":55,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,1,15]]},"published-print":{"date-parts":[[2018,1,15]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.201703-0536oc","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.731250921.793572556","asserted-by":"object"}],"is-referenced-by":[{"id-type":"doi","id":"10.1186\/s13054-025-05810-z","asserted-by":"object"}]},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,1]]},"published":{"date-parts":[[2018,1]]}}}