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S) might be involved [60].ConclusionWe confirm that, within a few hours
S) might be involved [60].ConclusionWe confirm that, within a few hours, CMV alters diaphragmatic muscle protein metabolism. CMV first reduces protein synthesis and then increases proteolysis. Compared with CMV, PSV limits muscle wasting through a better protein balance despite marked oxidative stress. If further study confirms our biochemical findings with histological and electromyographical data, PSV may be an alternative to CMV to limit muscle atrophy and diaphragmatic dysfunction. Key messages ???Controlled mechanical ventilation reduces protein synthesis and secondly increases proteolysis. Pressure support ventilation limits muscle wasting through a better protein balance. Pressure Support Ventilation may be an alternative to Controlled mechanical Ventilation to limit diaphragmatic atrophy.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsEF and J-MC participated in the design of the study, carried out the study, and helped to draft the manuscript. They contributed equally to this work. LC, LM, LR, VS, and DA partici-Page 7 of(page number not for citation purposes)Critical CareVol 12 NoFutier et al.pated in the design of the study, performed biochemical analysis, and helped to draft the manuscript. SJ, BJ and J-EB participated in the design of the study and helped to draft the manuscript. All authors read and approved the final manuscript.17.18. 19. 20.AcknowledgementsThe authors thank Scott Butler for manuscript editing, Jean-Paul Mission for statistical analysis, the members of the CICE-CENTI Unit, Faculty of Medicine, Clermont-Ferrand, France, for their assistance, and the members of the Human Nutrition Unit, Institut National de la Recherche Agronomique, for their technical and scientific support. This work was supported by the university hospital of Clermont-Ferrand.21. 22. 23. 24.
Abnormalities of ventilation are an important part of the septic syndrome [1], and an understanding of the pathophysiology of these disorders is essential in the management of septic patients. Disorders of ventilation can be broadly classified as abnormalities related to the following: ventilatory drive; GrazoprevirMedChemExpress MK-5172 function of the ventilatory pump, which is dependent upon the supply of energy, the demand for energy and the intrinsic function of the muscle; and abnormalities related to the interaction of the ventilatory and cardiovascular systems (heartlung interactions). In this review I discuss each of these, giving emphasis to mechanical factors. Some aspects of these topics were reviewed previously [2-8].Abnormalities of ventilatory driveA characteristic of sepsis, and part of the definition of the systemic inflammatory syndrome, is an increase in respiratory rate [9]. An increase in respiratory rate can occur with an increase in total ventilation or with a fall in tidal volume, in which case there is no change in total ventilation. At least in PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26577270 the early stages, most often total ventilation increases, although in later stages the ratio of respiratory rate to volumeFOXO = forkhead box O; IL = interleukin; NO = nitric oxide; NOS = nitric oxide synthase; PCO2 = partial pressure of carbon dioxide; PEEP = positive end-expiratory pressure; PTI = pressure-time index; ROS = reactive oxygen species; TNF = tumour necrosis factor.Page 1 of(page number not for citation purposes)Critical CareVol 13 NoMagderFigureIncreased energy demands The energy needs of the ventilatory system are determined by the tension produced by t.

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