Ventilator Induced Diaphramatic Dysfunction in Recepients and Donors scheduled for Living Donor Liver Transplantation

• Ventilator-induced diaphragmatic dysfunction is a condition that occurs with the use of mechanical ventilation and is associated with adverse effects on the structure and function of the diaphragm. • The Dysfunction has been reported to occur even after ventilation for a duration of as little as 18 hours. (N Engl J Med. 2008) • Mechanical ventilation causes a significant decrease in diaphragmatic contractile force as well as atrophy of diaphragm muscle fibres. • Ventilator-induced diaphragmatic dysfunction can prolong weaning time and may be associated with poor weaning outcomes, ICU and hospital mortality. • Ventilator Induced Diaphragmatic Dysfunction may be exacerbated by the use of neuromuscular blockers and steroids. • Diaphragmatic ultrasonography at the bedside has been found to be safe and simple to conduct, allowing for both morphologic and functional examination of the muscle. • There are various causes that contribute to diaphragmatic dysfunction in Cirrhotics undergoing LDLT: 8 • Cirrhotics have an increase in intra-abdominal pressure as a result of ascites, which can affect the diaphragm function. • Sarcopenia in cirrhotics, has been shown to be an independent predictor for longer need of mechanical ventilation implying the connection with respiratory muscle sarcopenia. (Kou et al Plos 2017) • Hepatic Hydrothorax or associated pleural Effusion can also contribute to Dysfunction. (PLEASE-2) Study. Respirology. 2022) • Diaphragmatic paralysis can be caused by the application of a suprahepatic/caval clamp and the resulting crush injury to the phrenic nerve during orthotopic liver transplantation