Diaphragm Pathology in Critically Ill Patients With COVID-19 and Postmortem Findings From 3 Medical Centers | Critical Care Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Diaphragm Pathology in Critically Ill Patients With COVID-19 and Postmortem Findings From 3 Medical Centers

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are now widely recognized and have important clinical implications.1,2 To our knowledge, the association of SARS-CoV-2 with the respiratory muscles has not been studied. This is surprising, as the respiratory muscles drive alveolar ventilation and their weakness results in acute respiratory failure. In critically ill patients undergoing ventilation, respiratory muscle weakness prolongs mechanical ventilation and increases mortality.3 The aim of this study was to investigate the association of severe coronavirus disease 2019 (COVID-19) with the respiratory muscles in critically ill patients and compare the findings with those obtained from non-COVID-19 critically ill patients.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: September 10, 2020.

Published Online: November 16, 2020. doi:10.1001/jamainternmed.2020.6278

Corresponding Author: Coen Ottenheijm, PhD, Department of Physiology, Amsterdam UMC, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands (c.ottenheijm@amsterdamumc.nl).

Author Contributions: Dr Ottenheijm had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Shi, Boon, Heunks, Ottenheijm.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Shi, Heunks, Ottenheijm.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Shi, de Vries, Ottenheijm.

Obtained funding: Ottenheijm.

Administrative, technical, or material support: de Vries, Heunks, Ottenheijm.

Supervision: Vlaar, Boon, Heunks, Ottenheijm.

Conflict of Interest Disclosures: Dr de Vries reported grants from Amsterdam Cardiovascular Sciences during the conduct of the study and personal fees from a Dutch ultrasound center outside the submitted work. Dr Heunks reported personal fees from Getinge and grants from Liberate Medical outside the submitted work. No other disclosures were reported.

Dutch COVID-19 Diaphragm Investigators: Bernadette Schurink, MD, PhD, Eva Roos, MD, PhD, Hans W.M. Niessen, MD, PhD, Sylvia Bogaards, BSc, Stefan Conijn, BSc, Yeszamin L. Onderwater, MSc, Pedro Espinosa, MSc, Anke van Bergen, BSc, Diewertje I. Bink, MSc, Marloes van den Berg, MD (Amsterdam UMC, location VUMC),and Benno Kusters, MD, PhD (Radboudumc).

Funding/Support: The research reported in this work was supported by a grant from the National Institutes of Health/ Heart Lung and Blood Institute (R01HL121500 to Dr Ottenheijm).

Role of the Funder/Sponsor: The National Institutes of Health/ Heart Lung and Blood Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Gupta  A , Madhavan  MV , Sehgal  K ,  et al.  Extrapulmonary manifestations of COVID-19.   Nat Med. 2020;26(7):1017-1032. doi:10.1038/s41591-020-0968-3PubMedGoogle ScholarCrossref
2.
Solomon  IH , Normandin  E , Bhattacharyya  S ,  et al.  Neuropathological features of Covid-19.   N Engl J Med. 2020;383(10):989-992. doi:10.1056/NEJMc2019373PubMedGoogle ScholarCrossref
3.
Dres  M , Goligher  EC , Heunks  LMA , Brochard  LJ .  Critical illness-associated diaphragm weakness.   Intensive Care Med. 2017;43(10):1441-1452. doi:10.1007/s00134-017-4928-4PubMedGoogle ScholarCrossref
4.
Levine  S , Nguyen  T , Taylor  N ,  et al.  Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans.   N Engl J Med. 2008;358(13):1327-1335. doi:10.1056/NEJMoa070447PubMedGoogle ScholarCrossref
5.
Hooijman  PE , Beishuizen  A , Witt  CC ,  et al.  Diaphragm muscle fiber weakness and ubiquitin-proteasome activation in critically ill patients.   Am J Respir Crit Care Med. 2015;191(10):1126-1138. doi:10.1164/rccm.201412-2214OCPubMedGoogle ScholarCrossref
6.
Carfì  A , Bernabei  R , Landi  F ; Gemelli Against COVID-19 Post-Acute Care Study Group.  Persistent symptoms in patients after acute COVID-19.   JAMA. 2020;324(6):603-605. doi:10.1001/jama.2020.12603PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close