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  1. Article ; Online: Setting positive end-expiratory pressure: role in diaphragm-protective ventilation.

    Wennen, Myrte / Claassen, Wout / Heunks, Leo

    Current opinion in critical care

    2023  Volume 30, Issue 1, Page(s) 61–68

    Abstract: Purpose of review: With mechanical ventilation, positive end-expiratory pressure (PEEP) is applied to improve oxygenation and lung homogeneity. However, PEEP setting has been hypothesized to contribute to critical illness associated diaphragm ... ...

    Abstract Purpose of review: With mechanical ventilation, positive end-expiratory pressure (PEEP) is applied to improve oxygenation and lung homogeneity. However, PEEP setting has been hypothesized to contribute to critical illness associated diaphragm dysfunction via several mechanisms. Here, we discuss the impact of PEEP on diaphragm function, activity and geometry.
    Recent findings: PEEP affects diaphragm geometry: it induces a caudal movement of the diaphragm dome and shortening of the zone of apposition. This results in reduced diaphragm neuromechanical efficiency. After prolonged PEEP application, the zone of apposition adapts by reducing muscle fiber length, so-called longitudinal muscle atrophy. When PEEP is withdrawn, for instance during a spontaneous breathing trial, the shortened diaphragm muscle fibers may over-stretch which may lead to (additional) diaphragm myotrauma. Furthermore, PEEP may either increase or decrease respiratory drive and resulting respiratory effort, probably depending on lung recruitability. Finally, the level of PEEP can also influence diaphragm activity in the expiratory phase, which may be an additional mechanism for diaphragm myotrauma.
    Summary: Setting PEEP could play an important role in both lung and diaphragm protective ventilation. Both high and low PEEP levels could potentially introduce or exacerbate diaphragm myotrauma. Today, the impact of PEEP setting on diaphragm structure and function is in its infancy, and clinical implications are largely unknown.
    MeSH term(s) Humans ; Diaphragm ; Lung ; Positive-Pressure Respiration ; Respiration ; Respiration, Artificial/methods
    Language English
    Publishing date 2023-12-06
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000001126
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Interpretation of Diaphragmatic Force Measurements in Reverse Triggering in a Porcine Model.

    Wennen, Myrte / Jonkman, Annemijn H / Heunks, Leo

    American journal of respiratory and critical care medicine

    2022  Volume 207, Issue 7, Page(s) 953–954

    MeSH term(s) Animals ; Swine ; Diaphragm ; Muscle Contraction
    Language English
    Publishing date 2022-12-06
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202210-1943LE
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Diaphragm excursions as proxy for tidal volume during spontaneous breathing in invasively ventilated ICU patients.

    Janssen, Matthijs L / Jonkman, Annemijn H / Wennen, Myrte / Wils, Evert-Jan / Endeman, Henrik / Heunks, Leo

    Intensive care medicine experimental

    2023  Volume 11, Issue 1, Page(s) 73

    Abstract: There is a need to monitor tidal volume in critically ill patients with acute respiratory failure, given its relation with adverse clinical outcome. However, quantification of tidal volume in non-intubated patients is challenging. In this proof-of- ... ...

    Abstract There is a need to monitor tidal volume in critically ill patients with acute respiratory failure, given its relation with adverse clinical outcome. However, quantification of tidal volume in non-intubated patients is challenging. In this proof-of-concept study, we evaluated whether ultrasound measurements of diaphragm excursion could be a valid surrogate for tidal volume in patients with respiratory failure. Diaphragm excursions and tidal volumes were simultaneously measured in invasively ventilated patients (N = 21) and healthy volunteers (N = 20). Linear mixed models were used to estimate the ratio between tidal volume and diaphragm excursion. The tidal volume-diaphragm excursion ratio was 201 mL/cm in ICU patients [95% confidence interval (CI) 161-240 mL/cm], and 361 (294-428) mL/cm in healthy volunteers. An excellent association was shown within participants (R
    Language English
    Publishing date 2023-10-27
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2740385-3
    ISSN 2197-425X
    ISSN 2197-425X
    DOI 10.1186/s40635-023-00553-z
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  4. Article ; Online: Tissue Doppler Imaging of the Diaphragm: A Novel Approach but Too Early for Clinical Implementation?

    Jonkman, Annemijn H / Wennen, Myrte / Sklar, Michael C / de Korte, Chris / Tuinman, Pieter R

    American journal of respiratory and critical care medicine

    2020  Volume 202, Issue 12, Page(s) 1741–1742

    MeSH term(s) Critical Illness ; Diagnostic Imaging ; Diaphragm/diagnostic imaging ; Healthy Volunteers ; Humans ; Ultrasonography, Doppler
    Language English
    Publishing date 2020-09-22
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202007-2958LE
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  5. Article ; Online: Anatomical Variation in Diaphragm Thickness Assessed with Ultrasound in Healthy Volunteers.

    Haaksma, Mark E / van Tienhoven, Arne J / Smit, Jasper M / Heldeweg, Micah L A / Lissenberg-Witte, Birgit I / Wennen, Myrte / Jonkman, Annemijn / Girbes, Armand R J / Heunks, Leo / Tuinman, Pieter R

    Ultrasound in medicine & biology

    2022  Volume 48, Issue 9, Page(s) 1833–1839

    Abstract: Ultrasonography of the diaphragm in the zone of apposition has become increasingly popular to evaluate muscle thickness and thickening fraction. However, measurements in this anatomical location are frequently hindered by factors that constrain physical ... ...

    Abstract Ultrasonography of the diaphragm in the zone of apposition has become increasingly popular to evaluate muscle thickness and thickening fraction. However, measurements in this anatomical location are frequently hindered by factors that constrain physical accessibility or that alter diaphragm position. Therefore, other anatomical positions at the chest wall for transducer placement are used, but the variability in diaphragm thickness across the dome has not been systematically studied. The aim of this study was to evaluate anatomical variation of diaphragm thickness in 46 healthy volunteers on three ventrodorsal lines and two craniocaudal positions on these three lines. The intraclass correlation coefficient (ICC) for diaphragm thickness in the craniocaudal direction on the mid-axillary line was significantly higher than those on the posterior axillary and midclavicular lines, suggesting it had the lowest variability (ICC
    MeSH term(s) Diaphragm/diagnostic imaging ; Diaphragm/physiology ; Healthy Volunteers ; Humans ; Thorax ; Ultrasonography
    Language English
    Publishing date 2022-06-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 186150-5
    ISSN 1879-291X ; 0301-5629
    ISSN (online) 1879-291X
    ISSN 0301-5629
    DOI 10.1016/j.ultrasmedbio.2022.05.008
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  6. Article ; Online: Combining deep learning with 3D stereophotogrammetry for craniosynostosis diagnosis.

    de Jong, Guido / Bijlsma, Elmar / Meulstee, Jene / Wennen, Myrte / van Lindert, Erik / Maal, Thomas / Aquarius, René / Delye, Hans

    Scientific reports

    2020  Volume 10, Issue 1, Page(s) 15346

    Abstract: Craniosynostosis is a condition in which cranial sutures fuse prematurely, causing problems in normal brain and skull growth in infants. To limit the extent of cosmetic and functional problems, swift diagnosis is needed. The goal of this study is to ... ...

    Abstract Craniosynostosis is a condition in which cranial sutures fuse prematurely, causing problems in normal brain and skull growth in infants. To limit the extent of cosmetic and functional problems, swift diagnosis is needed. The goal of this study is to investigate if a deep learning algorithm is capable of correctly classifying the head shape of infants as either healthy controls, or as one of the following three craniosynostosis subtypes; scaphocephaly, trigonocephaly or anterior plagiocephaly. In order to acquire cranial shape data, 3D stereophotographs were made during routine pre-operative appointments of scaphocephaly (n = 76), trigonocephaly (n = 40) and anterior plagiocephaly (n = 27) patients. 3D Stereophotographs of healthy infants (n = 53) were made between the age of 3-6 months. The cranial shape data was sampled and a deep learning network was used to classify the cranial shape data as either: healthy control, scaphocephaly patient, trigonocephaly patient or anterior plagiocephaly patient. For the training and testing of the deep learning network, a stratified tenfold cross validation was used. During testing 195 out of 196 3D stereophotographs (99.5%) were correctly classified. This study shows that trained deep learning algorithms, based on 3D stereophotographs, can discriminate between craniosynostosis subtypes and healthy controls with high accuracy.
    MeSH term(s) Case-Control Studies ; Craniosynostoses/diagnostic imaging ; Deep Learning ; Facial Bones/diagnostic imaging ; Head/abnormalities ; Head/anatomy & histology ; Humans ; Imaging, Three-Dimensional/methods ; Infant ; Photogrammetry
    Language English
    Publishing date 2020-09-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-020-72143-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Positive end-expiratory pressure affects geometry and function of the human diaphragm.

    Jansen, Diana / Jonkman, Annemijn H / Vries, Heder J de / Wennen, Myrte / Elshof, Judith / Hoofs, Maud A / van den Berg, Marloes / Man, Angélique M E de / Keijzer, Christiaan / Scheffer, Gert-Jan / van der Hoeven, Johannes G / Girbes, Armand / Tuinman, Pieter Roel / Marcus, J Tim / Ottenheijm, Coen A C / Heunks, Leo

    Journal of applied physiology (Bethesda, Md. : 1985)

    2021  Volume 131, Issue 4, Page(s) 1328–1339

    Abstract: Positive end-expiratory pressure (PEEP) is routinely applied in mechanically ventilated patients to improve gas exchange and respiratory mechanics by increasing end-expiratory lung volume (EELV). In a recent experimental study in rats, we demonstrated ... ...

    Abstract Positive end-expiratory pressure (PEEP) is routinely applied in mechanically ventilated patients to improve gas exchange and respiratory mechanics by increasing end-expiratory lung volume (EELV). In a recent experimental study in rats, we demonstrated that prolonged application of PEEP causes diaphragm remodeling, especially longitudinal muscle fiber atrophy. This is of potential clinical importance, as the acute withdrawal of PEEP during ventilator weaning decreases EELV and thereby stretches the adapted, longitudinally atrophied diaphragm fibers to excessive sarcomere lengths, having a detrimental effect on force generation. Whether this series of events occurs in the human diaphragm is unknown. In the current study, we investigated if short-term application of PEEP affects diaphragm geometry and function, which are prerequisites for the development of longitudinal atrophy with prolonged PEEP application. Nineteen healthy volunteers were noninvasively ventilated with PEEP levels of 2, 5, 10, and 15 cmH
    MeSH term(s) Animals ; Diaphragm ; Humans ; Lung Volume Measurements ; Positive-Pressure Respiration ; Rats ; Respiration ; Respiration, Artificial/adverse effects
    Language English
    Publishing date 2021-09-02
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 219139-8
    ISSN 1522-1601 ; 0021-8987 ; 0161-7567 ; 8750-7587
    ISSN (online) 1522-1601
    ISSN 0021-8987 ; 0161-7567 ; 8750-7587
    DOI 10.1152/japplphysiol.00184.2021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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