{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T23:41:16Z","timestamp":1778802076646,"version":"3.51.4"},"reference-count":35,"publisher":"PAGEPress Publications","issue":"2","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Our study investigates the post-mortem findings of the diaphragm\u2019s muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 critically ill COVID-19 patients were analyzed and correlated with the type and length of mechanical ventilation (MV), ventilatory parameters, prone positioning, and use of sedative drugs. The mean number of fibers was 550\u00b1626. The cross-sectional area was 4120\u00b13280 \u03bcm2, while the muscular fraction was 0.607\u00b10.126. The overall population was clustered into two distinct populations (clusters 1 and 2). Cluster 1 showed a lower percentage of slow myosin fiber and higher fast fiber content than cluster 2 (68% vs. 82%, p&lt;0.00001, and 29.8% vs. 18.8%, p=0.00045, respectively). The median duration of MV was 180 (41-346) hours. In cluster 1, a relationship between assisted ventilation and fast myosin fiber percentage (R2=-0.355, p=0.014) was found. In cluster 2, fast fiber content increased with increasing length of the controlled MV (R2=0.446, p=0.006). A high grade of fibrosis was reported. Cluster 1 was characterized by fibers\u2019 atrophy and cluster 2 by hypertrophy, supposing different effects of ventilation on the diaphragm but without excluding a possible direct viral effect on diaphragmatic fibers.<\/jats:p>","DOI":"10.4081\/monaldi.2024.2829","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T07:43:34Z","timestamp":1713858214000},"source":"Crossref","is-referenced-by-count":1,"title":["Diaphragmatic morphological &lt;i&gt;post-mortem&lt;\/i&gt; findings in critically ill COVID-19 patients: an observational study"],"prefix":"10.4081","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3745-8368","authenticated-orcid":false,"given":"Luigi","family":"Vetrugno","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian","family":"Deana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savino","family":"Spadaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianmaria","family":"Cammarota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4557-6308","authenticated-orcid":false,"given":"Domenico Luca","family":"Grieco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3332-7459","authenticated-orcid":false,"given":"Annarita","family":"Tullio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5489-2898","authenticated-orcid":false,"given":"Tiziana","family":"Bove","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Di Loreto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1828-9143","authenticated-orcid":false,"given":"Salvatore Maurizio","family":"Maggiore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9978-8130","authenticated-orcid":false,"given":"Maria","family":"Orsaria","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DIASUS","family":"Study group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"39047","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2018.01.012"},{"key":"39048","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201206-1117CP"},{"key":"39049","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-022-06749-3"},{"key":"39050","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200202-088OC"},{"key":"39051","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa070447"},{"key":"39052","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201004-0670OC"},{"key":"39053","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e328334b166"},{"key":"39054","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4928-4"},{"key":"39055","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201703-0536OC"},{"key":"39056","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2010.12.015"},{"key":"39057","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.6278"},{"key":"39058","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202206-1243OC"},{"key":"39059","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-016-1556-2"},{"key":"39060","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202009-3467OC"},{"key":"39061","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.93.04050587"},{"key":"39062","doi-asserted-by":"publisher","DOI":"10.1016\/j.pulmoe.2022.11.002"},{"key":"39063","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-022-02138-y"},{"key":"39064","doi-asserted-by":"publisher","DOI":"10.1186\/s13089-023-00306-9"},{"key":"39065","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2003.009894"},{"key":"39066","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.00247"},{"key":"39067","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00816"},{"key":"39068","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-020-01462-5"},{"key":"39069","doi-asserted-by":"publisher","DOI":"10.1016\/j.tacc.2020.09.005"},{"key":"39070","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.162.5.9906033"},{"key":"39071","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1995.79.5.1640"},{"key":"39072","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2021-001052"},{"key":"39073","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2016.00623"},{"key":"39074","unstructured":"Deana C, Rovida S, Orso D, et al. 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