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We aimed to describe the variability in diaphragm contractile loading conditions during mechanical ventilation and to establish whether dyssynchronous diaphragm contractions are associated with the development of impaired diaphragm dysfunction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In patients receiving invasive mechanical ventilation for pneumonia, septic shock, acute respiratory distress syndrome, or acute brain injury, airway flow and pressure and diaphragm electrical activity (Edi) were recorded hourly around the clock for up to 7 days. Dyssynchronous post-inspiratory diaphragm loading was defined based on the duration of neural inspiration after expiratory cycling of the ventilator. Diaphragm function was assessed on a daily basis by neuromuscular coupling (NMC, the ratio of transdiaphragmatic pressure to diaphragm electrical activity).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 4508 hourly recordings were collected in 45 patients. Edi was low or absent (\u2264\u20095\u00a0\u00b5V) in 51% of study hours (median 71\u00a0h per patient, interquartile range 39\u2013101\u00a0h). Dyssynchronous post-inspiratory loading was present in 13% of study hours (median 7\u00a0h per patient, interquartile range 2\u201322\u00a0h). The probability of dyssynchronous post-inspiratory loading was increased with reverse triggering (odds ratio 15, 95% CI 8\u201335) and premature cycling (odds ratio 8, 95% CI 6\u201310). The duration and magnitude of dyssynchronous post-inspiratory loading were associated with a progressive decline in diaphragm NMC (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01 for interaction with time).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Dyssynchronous diaphragm contractions may impair diaphragm function during mechanical ventilation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>MYOTRAUMA, ClinicalTrials.gov NCT03108118. Registered 04 April 2017 (retrospectively registered).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13054-024-04894-3","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T13:02:18Z","timestamp":1712062938000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Dyssynchronous diaphragm contractions impair diaphragm function in mechanically ventilated patients"],"prefix":"10.1186","volume":"28","clinical-trial-number":[{"clinical-trial-number":"nct03108118","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Benjamin","family":"Coiffard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Dianti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Telias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent J.","family":"Brochard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur S.","family":"Slutsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Beck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christer","family":"Sinderby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niall D.","family":"Ferguson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewan C.","family":"Goligher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,2]]},"reference":[{"issue":"1","key":"4894_CR1","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/S2213-2600(18)30366-7","volume":"7","author":"EC Goligher","year":"2019","unstructured":"Goligher EC, Brochard LJ, Reid WD, Fan E, Saarela O, Slutsky AS, Kavanagh BP, Rubenfeld GD, Ferguson ND. 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If no substitute decision maker was available and to facilitate timely evaluation, eligible patients were enrolled by deferred consent and consent for the use of study data was obtained from study participants once they regained capacity.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Coiffard reports receiving support for attending meetings and\/or travel from Biotest. Dr. Telias reports receiving consulting fees from MBMed SA, and support for presentation from Medtronic and Getinge. Dr. Brochard reports receiving grants from Medtronic, Stimit, and Vitalaire and support for attending meetings and\/or travel from Fisher Paykel. Dr. Slutsky reports receiving consulting fees from Stimit. Drs. Beck and Sinderby have been reimbursed by Maquet Critical Care (Solna, Sweden) for attending several conferences; JB and CS have participated as a speaker in scientific meetings or courses organized and financed by Maquet Critical Care; JB and CS, through Neurovent Research, serve as consultants to Maquet Critical Care. The following disclosure was agreed upon by University of Toronto, Sunnybrook Health Sciences Centre, St-Michael's Hospital and the REBs of Sunnybrook and St-Michael's to resolve conflicts of interest: Drs. Beck and Sinderby have made inventions related to neural control of mechanical ventilation that are patented. The patents are assigned to the academic institution(s) where inventions were made. The license for these patents belongs to Maquet Critical Care. Future commercial uses of this technology may provide financial benefit to Dr. Beck and Dr. Sinderby through royalties. Dr. Beck and Dr. Sinderby each own 50% of Neurovent Research Inc (NVR). NVR is a research and development company that builds the equipment and catheters for research studies. NVR has a consulting agreement with Maquet Critical Care. Dr. Goligher reports receiving grants from the Canadian Institutes of Health Research and National Sanitarium Association; consulting fees from Lungpacer Medical, Stimit LLC, and Bioage; honoraria for lectures from Vyaire, Draeger, and Getinge; advisory board participation for Getinge (current) and Lungpacer (previous); and receipt of equipment for research from Timpel and Lungpacer.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"107"}}