{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T11:23:40Z","timestamp":1770895420677,"version":"3.50.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T00:00:00Z","timestamp":1640131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Patients with acute respiratory failure (ARF) may need mechanical ventilation (MV), which can lead to diaphragmatic dysfunction and muscle wasting, thus making difficult the weaning from the ventilator. Currently, there are no biomarkers specific for respiratory muscle and their function can only be assessed trough ultrasound or other invasive methods. Previously, the fast and slow isoform of the skeletal troponin I (fsTnI and ssTnI, respectively) have shown to be specific markers of muscle damage in healthy volunteers. We aimed therefore at describing the trend of skeletal troponin in mixed population of ICU patients undergoing weaning from mechanical ventilation and compared the value of fsTnI and ssTnI with diaphragmatic ultrasound derived parameters.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> In this prospective observational study we enrolled consecutive patients recovering from acute hypoxemic respiratory failure (AHRF) within 24 h from the start of weaning. Every day an arterial blood sample was collected to measure fsTnI, ssTnI, and global markers of muscle damage, such as ALT, AST, and CPK. Moreover, thickening fraction (TF) and diaphragmatic displacement (DE) were assessed by diaphragmatic ultrasound. The trend of fsTnI and ssTnI was evaluated during the first 3 days of weaning.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> We enrolled 62 consecutive patients in the study, with a mean age of 67 \u00b1 13 years and 43 of them (69%) were male. We did not find significant variations in the ssTnI trend (<jats:italic>p<\/jats:italic> = 0.623), but fsTnI significantly decreased over time by 30% from Day 1 to Day 2 and by 20% from Day 2 to Day 3 (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). There was a significant interaction effect between baseline ssTnI and DE [<jats:italic>F<\/jats:italic><jats:sub>(2)<\/jats:sub> = 4.396, <jats:italic>p<\/jats:italic> = 0.015], with high basal levels of ssTnI being associated to a higher decrease in DE. On the contrary, the high basal levels of fsTnI at day 1 were characterized by significant higher DE at each time point.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Skeletal muscle proteins have a distinctive pattern of variation during weaning from mechanical ventilation. At day 1, a high basal value of ssTnI were associated to a higher decrease over time of diaphragmatic function while high values of fsTnI were associated to a higher displacement at each time point.<\/jats:p>","DOI":"10.3389\/fmed.2021.770408","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T07:45:34Z","timestamp":1640159134000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Circulating Skeletal Troponin During Weaning From Mechanical Ventilation and Their Association to Diaphragmatic Function: A Pilot Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Savino","family":"Spadaro","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Dalla Corte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Scaramuzzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Grasso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilda","family":"Cinnella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Rosta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Chiavieri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Alvisi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"Di Mussi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo Alberto","family":"Volta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiziana","family":"Bellini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Trentini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1164\/rccm.201605-1081CP","article-title":"Mechanical ventilation to minimize progression of lung injury in acute respiratory failure","volume":"195","author":"Brochard","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13054-015-1178-0","article-title":"Impact of prolonged assisted ventilation on diaphragmatic efficiency: NAVA versus PSV","volume":"20","author":"Di Mussi","year":"2016","journal-title":"Crit Care"},{"key":"B3","doi-asserted-by":"publisher","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":"B4","doi-asserted-by":"publisher","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":"B5","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1097\/CCM.0b013e31823c8cc9","article-title":"Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy","volume":"40","author":"Hudson","year":"2012","journal-title":"Crit Care Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1164\/rccm.200304-489CP","article-title":"Ventilator-induced diaphragmatic dysfunction","volume":"169","author":"Vassilakopoulos","year":"2004","journal-title":"Am J Respir Crit Care Med"},{"key":"B7","doi-asserted-by":"publisher","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":"B8","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1164\/rccm.202003-0655CP","article-title":"Lung- and diaphragm-protective ventilation","volume":"202","author":"Goligher","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1164\/rccm.201703-0536OC","article-title":"Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes","volume":"197","author":"Goligher","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1186\/s13054-016-1479-y","article-title":"Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index","volume":"20","author":"Spadaro","year":"2016","journal-title":"Crit Care"},{"key":"B11","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1186\/s13054-020-03357-9","article-title":"Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients","volume":"24","author":"Di Mussi","year":"2020","journal-title":"Crit Care."},{"key":"B12","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1007\/s00134-012-2504-5","article-title":"Titin and diaphragm dysfunction in mechanically ventilated rats","volume":"38","author":"van Hees","year":"2012","journal-title":"Intensive Care Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1164\/rccm.200503-356OC","article-title":"Weaning prediction: esophageal pressure monitoring complements readiness testing","volume":"171","author":"Jubran","year":"2005","journal-title":"Am J Respir Crit Care Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1007\/s00134-015-4174-6","article-title":"Is the ventilator switching from inspiration to expiration at the right time?","volume":"42","author":"Mojoli","year":"2016"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1164\/rccm.201605-0992OC","article-title":"The diaphragm acts as a brake during expiration to prevent lung collapse","volume":"195","author":"Pellegrini","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1186\/s13054-019-2682-4","article-title":"Expiratory flow limitation in intensive care: prevalence and risk factors","volume":"23","author":"Volta","year":"2019","journal-title":"Crit Care"},{"key":"B17","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13613-018-0401-y","article-title":"Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study","volume":"8","author":"Dres","year":"2018","journal-title":"Ann Intensive Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1093\/clinchem\/48.7.1112","article-title":"Differential detection of skeletal troponin I isoforms in serum of a patient with rhabdomyolysis: markers of muscle injury?","volume":"48","author":"Simpson","year":"2002","journal-title":"Clin Chem"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1152\/jappl.1997.83.4.1076","article-title":"Skeletal troponin I as a marker of exercise-induced muscle damage","volume":"83","author":"Sorichter","year":"1997","journal-title":"J Appl Physiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.jsams.2012.05.006","article-title":"Changes in serum fast and slow skeletal troponin I concentration following maximal eccentric contractions","volume":"16","author":"Chapman","year":"2013","journal-title":"J Sci Med Sport"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.1007\/s00421-012-2337-5","article-title":"Serum skeletal troponin I following inspiratory threshold loading in healthy young and middle-aged men","volume":"112","author":"Foster","year":"2012","journal-title":"Eur J Appl Physiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"010703","DOI":"10.11613\/BM.2019.010703","article-title":"Fast skeletal troponin I, but not the slow isoform, is increased in patients under statin therapy: a pilot study","volume":"29","author":"Trentini","year":"2019","journal-title":"Biochem Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1186\/cc11454","article-title":"Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)","volume":"17","author":"Kellum","year":"2013","journal-title":"Crit Care"},{"key":"B24","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1097\/ALN.0000000000002774","article-title":"Point of care ultrasound to identify diaphragmatic dysfunction after thoracic surgery","volume":"131","author":"Spadaro","year":"2019","journal-title":"Anesthesiology"},{"key":"B25","doi-asserted-by":"publisher","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":"B26","doi-asserted-by":"publisher","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":"B27","doi-asserted-by":"publisher","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":"B28","doi-asserted-by":"publisher","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":"B29","doi-asserted-by":"publisher","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":"B30","doi-asserted-by":"publisher","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":"B31","doi-asserted-by":"crossref","DOI":"10.4324\/9781315744094","volume-title":"Longitudinal Analysis: Modeling Within-Person Fluctuation and Change","author":"Hoffman","year":"2015"},{"key":"B32","doi-asserted-by":"publisher","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":"B33","doi-asserted-by":"publisher","first-page":"R120","DOI":"10.1186\/cc12792","article-title":"Diaphragm weakness in mechanically ventilated critically ill patients","volume":"17","author":"Supinski","year":"2013","journal-title":"Crit Care"},{"key":"B34","first-page":"423","article-title":"Creatine kinase MB during myocardial infarction: relationship to preexisting coronary heart disease and medication","volume":"52","author":"Sax","year":"1997","journal-title":"Acta Cardiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1002\/mus.27222","article-title":"Elevation of fast but not slow troponin I in the circulation of patients with Becker and Duchenne muscular dystrophy","volume":"64","author":"Barthel","year":"2021","journal-title":"Muscle Nerve"},{"key":"B36","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1373\/clinchem.2004.042671","article-title":"Fast and slow skeletal troponin I in serum from patients with various skeletal muscle disorders: a pilot study","volume":"51","author":"Simpson","year":"2005","journal-title":"Clin Chem"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1097\/ALN.0000000000003191","article-title":"Usefulness of parasternal intercostal muscle ultrasound during weaning from mechanical ventilation","volume":"132","author":"Dres","year":"2020","journal-title":"Anesthesiology"},{"key":"B38","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1183\/09031936.95.08010114","article-title":"Time constant\/volume relationship of passive expiration in mechanically ventilated ARDS patients","volume":"8","author":"Guttmann","year":"1995","journal-title":"Eur Respir J"},{"key":"B39","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1097\/ALN.0000000000002605","article-title":"Lung- and diaphragm-protective ventilation in acute respiratory distress syndrome: rationale and challenges","volume":"130","author":"Schepens","year":"2019","journal-title":"Anesthesiology"},{"key":"B40","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1186\/s13054-020-2777-y","article-title":"Monitoring patient respiratory effort during mechanical ventilation: lung and diaphragm-protective ventilation","volume":"24","author":"Bertoni","year":"2020","journal-title":"Crit Care."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1016\/j.chest.2021.07.006","article-title":"Can abdominal muscle ultrasonography during spontaneous breathing and cough predict reintubation in mechanically ventilated patients?","volume":"160","author":"Spadaro","year":"2021","journal-title":"Chest."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.770408\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T07:45:41Z","timestamp":1640159141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.770408\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,22]]},"references-count":41,"alternative-id":["10.3389\/fmed.2021.770408"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.770408","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,22]]},"article-number":"770408"}}