Fig. 1.

Summary of the current understanding of the molecular pathways contributing to ventilator-induced diaphragm dysfunction (VIDD) in critically ill patients. As shown, different conditions can lead to diaphragm atrophy via an imbalance between proteolysis and protein synthesis [11, 14], whereas remaining muscle proteins may be impaired by enhanced oxidation and dephosphorylation [15–17]. Inflammation and oxidative stress are proposed to be the major drivers of these impairments [17]. In addition, certain drugs can impair neural drive and excitation-contraction coupling