Wout J Claassen

1 Introduction Weakness of the diaphragm frequently develops in ventilated critically ill patients. This contributes to difficult weaning, which is associated with increased morbidity, mortality and healthcare costs [1]. Furthermore, it can lead to physical disability and long-term impairment in intensive care survivors [2]. Diaphragm weakness is caused by a combination of atrophy and dysfunction of the remaining contractile material, leading to weakness of muscle cells (i.e., myofibers).

Editor’s summary Many ventilated patients develop weakness of the diaphragm that can result in extubation failure; however, the underlying molecular mechanisms of this diaphragm weakness are incompletely understood.