Just Breathe 101 Diaphragm in Critical Care

A student letter reveals how diaphragm dysfunction in critical care became clinically applicable, changing a therapist’s treatment approach and prompting deeper exploration of critical care patient issues.

Describe the diaphragm's anatomy, innervation, and blood supply. Identify four causes of diaphragmatic innervation damage, factors in icu-acquired weakness, and the pros and cons of early mobilization in the icu.

Explore diaphragm anatomy: crura origins from L1–L3 and the central tendon. Identify three openings— aortic at T12, esophageal at T10, vena cava at T8–9— and phrenic nerve innervation from C3–C5.

Diaphragm dysfunction arises from neurological input loss via the phrenic nerve (C3–5) and anatomical defects like diaphragmatic hernias, reducing excursion and compromising breathing, often requiring ventilation and repair.

Examine acquired diaphragmatic injuries from blunt force trauma, especially motor vehicle collisions, with left-side predominance, potential bilateral rupture, and associated pelvic fractures, thoracic aorta injuries, and liver or spleen damage.

This lecture divides diaphragm rupture into acute, latent, and late types, stresses delayed rupture risks, and reviews laparoscopy or thoracotomy as preferred repairs, with laparoscopy showing shorter hospital stays.

Ventilator induced diaphragm dysfunction (vidd) arises during positive pressure ventilation, causing rapid diaphragm disuse atrophy and weaning failure, with sepsis, malnutrition, electrolyte issues, and prolonged ventilation as risk factors.

Use diaphragmatic ultrasound to assess diaphragm excursion and thickening at the bedside with portable, non-invasive equipment. Explore its role in detecting diaphragm dysfunction, including COVID-19-related dysfunction and critical illness myopathy.

Examine early mobilization in the ICU and diaphragmatic retraining strategies, including tactile diaphragmatic techniques, rib springing, and pursed-lip breathing, to improve breathing, trunk control, and recovery.

Examine prevention strategies for the diaphragm in critical care, including short-term corticosteroids, possible protective agents, inspiratory muscle training, and ventilation practices to support the diaphragm and prevent atrophy.