rojournalРоссийский остеопатический журналRussian Osteopathic Journal2220-09752949-3064All-Russian Public Organization «Russian Osteopathic Association» (ROsA)10.32885/2220-0975-2025-1-125-140rojournal-655Research ArticleОБЗОРЫREVIEWSФункции диафрагмы и их нарушение при искусственной вентиляции легких (обзор литературы)Diaphragm functions and their disorder during artificial ventilation of the lungs (literature review)https://orcid.org/0009-0000-9040-2465ТолмачевК. М.TolmachevK. M.

Константин Михайлович Толмачев, врач-трансфузиолог

115446, Москва, Коломенский проезд, д. 4

Konstantin М. Tolmachev, transfusiologist

bld. 4 Kolomenskiy proezd, Moscow, 115446

 

https://orcid.org/0000-0001-8674-5633ПотехинаЮ. П.PotekhinaYu. P.

Юлия Павловна Потехина, докт. мед. наук, профессор, Приволжский исследовательский медицинский университет, профессор кафедры нормальной физиологии им. Н. Ю. Беленкова; Институт остеопатии, заместитель директора по научно-методической работе

191024, Санкт-Петербург, ул. Дегтярная, д. 1, лит. А,

603005, Нижний Новгород, пл. Минина и Пожарского, д. 10/1

Scopus Author ID: 55318321700

Yulia P. Potekhina, Dr. Sci. (Med.), Professor, Privolzhsky Research Medical University, Professor at the N. Yu. Belenkov Department of Normal Physiology; Institute of Osteopathy, Deputy Director for Scientific and Methodological Work

bld. 1 lit. A ul. Degtyarnaya, Saint-Petersburg, 191024,

bld. 10/1 Minin and Pozharsky sq., Nizhny Novgorod, 603005

Scopus Author ID: 55318321700 

newtmed@gmail.comГородская клиническая больница им. С. С. ЮдинаРоссияCity Clinical Hospital named after S.S. YudinRussian FederationИнститут остеопатии; Приволжский исследовательский медицинский университетРоссияInstitute of Osteopathy; Privolzhsky Research Medical UniversityRussian Federation20252403202501125140Copyright © Толмачев К.М., Потехина Ю.П., 20252025Толмачев К.М., Потехина Ю.П.Tolmachev K.M., Potekhina Y.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rojournal.elpub.ru/jour/article/view/655

Целью данного обзора была систематизация функций диафрагмы и их нарушений, возникающих при ис­кусственной вентиляции легких (ИВЛ), а также оценка возможностей их остеопатической коррекции. Диа­фрагма является не только главной дыхательной мышцей, но и принимает участие в функционировании сер­дечно-сосудистой, пищеварительной и других систем организма, включая центральную нервную систему. Следовательно, дисфункции диафрагмы негативно отражаются на состоянии всего организма. Они могут формироваться по разным причинам, в том числе у пациентов, длительно находящихся на ИВЛ. Инструмен­тальная диагностика дисфункций диафрагмы не разработана, но врачи-остеопаты владеют техниками их ди­агностики и коррекции. Найдено относительно небольшое количество публикаций, доказывающих положи­тельное влияние остеопатической коррекции на функцию внешнего дыхания. Остеопатическое воздействие на диафрагму имеет потенциальную пользу для сокращения времени пребывания пациентов на ИВЛ и их реабилитации после. В доступной литературе таких исследований не найдено, однако они имеют высокую актуальность и могут открыть новые перспективы для применения остеопатической коррекции.

The aim of this review was to systematize the functions of the diaphragm and their disorders occurring during artificial lung ventilation, as well as to evaluate the possibilities of their osteopathic correction. The diaphragm is not only the main respiratory muscle, but also takes part in the functioning of cardiovascular, digestive and other systems of the body, including the central nervous system. Consequently, dysfunctions of the diaphragm negatively affect the condition of the entire body. They can be formed for various reasons, including in patients who are on artificial lung ventilation for a long time. Instrumental diagnosis of diaphragm dysfunction has not been developed, but osteopathic physicians have techniques for both diagnosis and correction of diaphragm dysfunction. There are relatively few publications proving the positive effect of osteopathic correction on external respiratory function. Osteopathic treatment of the diaphragm has potential benefit in reducing the time patients spend on ventilator and their rehabilitation afterwards. No such studies were found in the available literature, but they are highly relevant and may open new perspectives for the application of osteopathic correction.

диафрагмаискусственная вентиляция легкихвнешнее дыханиедисфункция диафрагмыостеопатическая коррекцияdiaphragmartificial ventilation of the lungsexternal respirationdiaphragm dysfunctionosteopathic correctionReferencesЧурсин В. В. Искусственная вентиляция легких: Учеб.-метод. пособие. Алматы; 2008.Chursin V. V. Artifi cial ventilation of lungs: Training manual. Almaty; 2008 (in russ.).Zilberberg M. D., Marjolein W., Pirone J. R., Shorr A. F. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Crit. Care Med. 2008; 36 (5): 1451–1455. https://doi.org/10.1097/CCM.0b013e3181691a49Zilberberg M. D., Marjolein W., Pirone J. R., Shorr A. F. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Crit. Care Med. 2008; 36 (5): 1451–1455. https://doi.org/10.1097/CCM.0b013e3181691a49Матюшков Н. С., Тюрин И. Н., Авдейкин С. Н., Боярков А. В. и др. Респираторная поддержка у пациентов с COVID-19. Опыт инфекционного госпиталя в Коммунарке: одноцентровое ретроспективное исследование. Вестн. интенсив. тер. им. А. И. Салтанова. 2021; 3: 47–60. https://doi.org/10.21320/1818-474X-2021-3-47-60Matiushkov N. S., Tyurin I. N., Avdeikin S. N., Boyarkov A. V. et al. Respiratory support in COVID-19 patients in Kommunarka hospital: A single-centered, retrospective study. Bull. crit. Care. 2021; 3: 47–60. https://doi.org/10.21320/1818-474X-2021-3-47-60 (in russ.).Villalba D., Gil Rossetti G., Scrigna M., Collins J. et al. Prevalence of and risk factors for mechanical ventilation reinstitution in patients weaned from prolonged mechanical ventilation. Resp. Care. 2020; 65 (2): 210–216. https://doi.org/10.4187/respcare.06807Villalba D., Gil Rossetti G., Scrigna M., Collins J. et al. Prevalence of and risk factors for mechanical ventilation reinstitution in patients weaned from prolonged mechanical ventilation. Resp. Care. 2020; 65 (2): 210–216. https://doi.org/10.4187/respcare.06807Rothaar R. C., Epstein S. K. Extubation failure: magnitude of the problem, impact on outcomes, and prevention. Curr. Opin. Crit. Care. 2003; 9 (1): 59–66. https://doi.org/10.1097/00075198-200302000-00011Rothaar R. C., Epstein S. K. Extubation failure: magnitude of the problem, impact on outcomes, and prevention. Curr. Opin. Crit. Care. 2003; 9 (1): 59–66. https://doi.org/10.1097/00075198-200302000-00011Epstein S. K. Weaning from ventilatory support. Curr. Opin. crit. Care. 2009; 15 (1): 36–43. https://doi.org/10.1097/MCC.0b013e3283220e07Epstein S. K. Weaning from ventilatory support. Curr. Opin. crit. Care. 2009; 15 (1): 36–43. https://doi.org/10.1097/MCC.0b013e3283220e07Funk G. C., Anders S., Breyer M. K., Burghuber O. C. et al. Incidence and outcome of weaning from mechanical ventilation according to new categories. Europ. Resp. J. 2010; 35: 88–94. https://doi.org/10.1183/09031936.00056909Funk G. C., Anders S., Breyer M. K., Burghuber O. C. et al. Incidence and outcome of weaning from mechanical ventilation according to new categories. Europ. Resp. J. 2010; 35: 88–94. https://doi.org/10.1183/09031936.00056909Jeong B. H., Ko M. G., Nam J., Yoo H. et al. Differences in clinical outcomes according to weaning classifi cations in medical intensive care units. PLOS ONE. 2015; 10 (4): e0122810. https://doi.org/10.1371/journal.pone.0122810Jeong B. H., Ko M. G., Nam J., Yoo H. et al. Differences in clinical outcomes according to weaning classifi cations in medical intensive care units. PLOS ONE. 2015; 10 (4): e0122810. https://doi.org/10.1371/journal.pone.0122810Roberts H. C. Imaging the diaphragm. Thorac. Surg. Clin. 2009; 19 (4): 431–450. PMID: 20112626. https://doi.org/10.1016/j.thorsurg.2009.08.008Roberts H. C. Imaging the diaphragm. Thorac. Surg. Clin. 2009; 19 (4): 431–450. PMID: 20112626. https://doi.org/10.1016/j.thorsurg.2009.08.008Downey R. Anatomy of the Normal Diaphragm. Thorac. Surg. Clin. 2011; 21: 273–279. https://doi.org/10.1016/j.thorsurg.2011.01.001Downey R. Anatomy of the Normal Diaphragm. Thorac. Surg. Clin. 2011; 21: 273–279. https://doi.org/10.1016/j.thorsurg.2011.01.001Greenman Ph.E. Principles of manual medicine. Lippincott Williams & Wilkins; 2003: 613.Greenman Ph.E. Principles of manual medicine. Lippincott Williams & Wilkins; 2003: 613.Bordoni B., Zanier E. Anatomic connections of the diaphragm: infl uence of respiration on the body system. J. Multidiscip. Hlthe. 2013; 6: 281–291. https://doi.org/10.2147/JMDH.S45443Bordoni B., Zanier E. Anatomic connections of the diaphragm: infl uence of respiration on the body system. J. Multidiscip. Hlthe. 2013; 6: 281–291. https://doi.org/10.2147/JMDH.S45443Sagrillo L., Frigo L. The respiratory diaphragm in osteopathic vision: A literature review. Manual Ther. Posturol. Rehab. J. 2020; 414 (14): 1–6. https://doi.org/10.17784/mtprehabjournal.2016.14.0414.Sagrillo L., Frigo L. The respiratory diaphragm in osteopathic vision: A literature review. Manual Ther. Posturol. Rehab. J. 2020; 414 (14): 1–6. https://doi.org/10.17784/mtprehabjournal.2016.14.0414.Bordoni B., Simonelli M. The awareness of the fascial system. Cureus. 2018; 10 (10): e3397. https://doi.org/10.7759/cureus.3397Bordoni B., Simonelli M. The awareness of the fascial system. Cureus. 2018; 10 (10): e3397. https://doi.org/10.7759/cureus.3397Bordoni B. The fi ve diaphragms in osteopathic manipulative medicine: myofascial relationships, part 1. Cureus. 2020; 12 (4): e7794. https://doi.org/10.7759/cureus.7794Bordoni B. The fi ve diaphragms in osteopathic manipulative medicine: myofascial relationships, part 1. Cureus. 2020; 12 (4): e7794. https://doi.org/10.7759/cureus.7794Борзых А. А., Виноградова О. Л., Тарасова О. С. Диафрагма: связь регуляции кровоснабжения с особенностями сократительной функции. Вестн. МГУ (серия 16 «Биология»). 2020; 75 (2): 55–64.Borzykh A. A., Vinogradova O. L., Tarasova O. S. Diaphragm: relationship between the regulation of blood supply and the characteristics of the contractile function. Vestn. MGU (seriya 16 «Biologiya»). 2020; 75 (2): 55–64 (in russ.).Loukas M., Du Plessis M., Louis R. G. Jr., Tubbs R. S. et al. The subdiaphragmatic part of the phrenic nerve — morphometry and connections to autonomic ganglia. Clin. Anat. 2016; 29 (1): 120–128. https://doi.org/10.1002/ca.22652Loukas M., Du Plessis M., Louis R. G. Jr., Tubbs R. S. et al. The subdiaphragmatic part of the phrenic nerve — morphometry and connections to autonomic ganglia. Clin. Anat. 2016; 29 (1): 120–128. https://doi.org/10.1002/ca.22652Bordoni B., Zanier E. The continuity of the body: hypothesis of treatment of the fi ve diaphragms. J. Altern. Compl. Med. 2015; 21 (4): 237–242. https://doi.org/10.1089/acm.2013.0211Bordoni B., Zanier E. The continuity of the body: hypothesis of treatment of the fi ve diaphragms. J. Altern. Compl. Med. 2015; 21 (4): 237–242. https://doi.org/10.1089/acm.2013.0211Физиология человека (в 3-х т.). Т. 2 (пер. с англ.) / Под ред. Р. Шмидта и Г. Тевса. М.: МИР; 1996: 313.Shmidt R., Tevs G. (eds.) Human Physiology (in 3 vols.). Vol. 2. M.: MIR; 1996: 313 (in russ.).Fogarty M. J., Sieck G. C. Evolution and functional differentiation of the diaphragm muscle of mammals. Compr. Physiol. 2019; 9 (2): 715–766. https://doi.org/10.1002/cphy.c180012Fogarty M. J., Sieck G. C. Evolution and functional differentiation of the diaphragm muscle of mammals. Compr. Physiol. 2019; 9 (2): 715–766. https://doi.org/10.1002/cphy.c180012Бюске Л. Мышечные цепи. Т. 2. Лордозы, кифозы, сколиозы и деформации грудной клетки. М.–Иваново: МИК; 2011.Byuske L. Muscle circuits. Vol. 2. Lordoses, kyphoses, scolioses and deformities of the thorax. M.–Ivanovo: MIK; 2011 (in russ.).Bordoni B., Marelli F., Morabito B., Sacconi B. et al. Low-back pain and gastroesophageal refl ux in patients with COPD: The disease in the breath. Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 325–334.Bordoni B., Marelli F., Morabito B., Sacconi B. et al. Low-back pain and gastroesophageal refl ux in patients with COPD: The disease in the breath. Int. J. Chron. Obstruct. Pulmon. Dis. 2018; 13: 325–334.Завьялов А. И., Завьялов Д. А., Завьялов А. А. Сердце — пятикамерная система. Теория и практика физ. культуры. 2005; 6: 23–26.Zavyalov A. I., Zavyalov D. A., Zavyalov A. A. The heart is a fi ve-chamber system. Teoriya i praktika fiz. kultury. 2005; 6: 23–26 (in russ.).Takizawa K., Matsumae M., Sunohara S., Yatsushiro S. et al. Characterization of cardiac- and respiratory-driven cerebrospinal fl uid motion based on asynchronous phase-contrast magnetic resonance imaging in volunteers. Fluids Barriers CNS. 2017; 14: 25.Takizawa K., Matsumae M., Sunohara S., Yatsushiro S. et al. Characterization of cardiac- and respiratory-driven cerebrospinal fl uid motion based on asynchronous phase-contrast magnetic resonance imaging in volunteers. Fluids Barriers CNS. 2017; 14: 25.Wszedybyl-Winklewska M., Wolf J., Swierblewska E., Kunicka К. et al. Increased inspiratory resistance affects the dynamic relationship between blood pressure changes and subarachnoid space width oscillations. PLoS One. 2017; 12: 179503. https://doi.org/10.1371/journal.pone.0179503Wszedybyl-Winklewska M., Wolf J., Swierblewska E., Kunicka К. et al. Increased inspiratory resistance affects the dynamic relationship between blood pressure changes and subarachnoid space width oscillations. PLoS One. 2017; 12: 179503. https://doi.org/10.1371/journal.pone.0179503Whedon J. M., Glassey D. Cerebrospinal fl uid stasis and its clinical signifi cance. Altern. Ther. Hlth Med. 2009; 15: 54–60.Whedon J. M., Glassey D. Cerebrospinal fl uid stasis and its clinical signifi cance. Altern. Ther. Hlth Med. 2009; 15: 54–60.Zelano C., Jiang H., Zhou G., Arora N. et al. Nasal respiration entrains human limbic oscillations and modulates cognitive function. J. Neurosci. 2016; 36: 12448–12467.Zelano C., Jiang H., Zhou G., Arora N. et al. Nasal respiration entrains human limbic oscillations and modulates cognitive function. J. Neurosci. 2016; 36: 12448–12467.Heck D. H., McAfee S. S., Liu Y., Babajani-Feremi А. et al. Breathing as a fundamental rhythm of brain function. Front Neural. Circ. 2017; 10: 115. https://doi.org/10.3389/fncir.2016.00115Heck D. H., McAfee S. S., Liu Y., Babajani-Feremi А. et al. Breathing as a fundamental rhythm of brain function. Front Neural. Circ. 2017; 10: 115. https://doi.org/10.3389/fncir.2016.00115Herrero J. L., Khuvis S., Yeagle E., Cerf M. et al. Breathing above the brain stem: volitional control and attentional modulation in humans. J. Neurophysiol. 2018; 119: 145–159.Herrero J. L., Khuvis S., Yeagle E., Cerf M. et al. Breathing above the brain stem: volitional control and attentional modulation in humans. J. Neurophysiol. 2018; 119: 145–159.Varga S., Heck D. H. Rhythms of the body, rhythms of the brain: respiration, neural oscillations, and embodied cognition. Consc. Cogn. 2017; 56: 77–90.Varga S., Heck D. H. Rhythms of the body, rhythms of the brain: respiration, neural oscillations, and embodied cognition. Consc. Cogn. 2017; 56: 77–90.Biskamp J., Bartos M., Sauer J. F. Organization of prefrontal network activity by respiration-related oscillations. Sci. Rep. 2017; 7: 45508.Biskamp J., Bartos M., Sauer J. F. Organization of prefrontal network activity by respiration-related oscillations. Sci. Rep. 2017; 7: 45508.Tsanov M. Speed and oscillations medial septum integration of attention and navigation. Front Syst. Neurosci. 2017; 11: 67.Tsanov M. Speed and oscillations medial septum integration of attention and navigation. Front Syst. Neurosci. 2017; 11: 67.Bordoni B., Marelli F., Morabito B., Sacconi B. Manual evaluation of the diaphragm muscle. Int. J. Chron. Obstruct. Pulmon. Dis. 2016; 11: 1949–1956. https://doi.org/10.2147/COPD.S111634Bordoni B., Marelli F., Morabito B., Sacconi B. Manual evaluation of the diaphragm muscle. Int. J. Chron. Obstruct. Pulmon. Dis. 2016; 11: 1949–1956. https://doi.org/10.2147/COPD.S111634Bordoni B., Purgol S., Bizzarri A., Modica M. et al. The Infl uence of Breathing on the Central Nervous System. Cureus. 2018; 10 (6): e2724. https://doi.org/10.7759/cureus.2724Bordoni B., Purgol S., Bizzarri A., Modica M. et al. The Infl uence of Breathing on the Central Nervous System. Cureus. 2018; 10 (6): e2724. https://doi.org/10.7759/cureus.2724Горячев А. С., Савин И. А. Основы ИВЛ. М.: МД; 2014.Goryachev A. S., Savin I. A. Fundamentals of ventilation. M.: MD; 2014 (in russ.).Curley G. F., Laffey J., Zhang H. Biotrauma and ventilator-induced lung injury: linical implications. Chest. 2016; 150 (5): 1109–1117. https://doi.org/10.1016/j.chest.2016.07.019Curley G. F., Laffey J., Zhang H. Biotrauma and ventilator-induced lung injury: linical implications. Chest. 2016; 150 (5): 1109–1117. https://doi.org/10.1016/j.chest.2016.07.019Понукалина Е. В., Полутова Н. В., Чеснокова Н. П., Бизенкова М. Н. Лекция 2: значение легких в обеспечении внешнего дыхания и недыхательных функций. Науч. обозрение. Мед. науки. 2017; 2: 34–35.Ponukalina E. V., Polutova N. V., Chesnokova N. P., Bizenkova M. N. Lecture 2: the importance of the lungs in providing external respiration and non-respiratory functions: Nauch. obozrenie. Med. nauki. 2017; 2: 34-35 (in russ.).Евлахов В. И., Поясов И. З. Венозный возврат и легочная гемодинамика при искусственной вентиляции легких с положительным давлением в конце выдоха. Мед. акад. журн. 2019; 19 (3): 11–20. https://doi.org/10.17816/MAJ19311-20Evlakhov V. I., Poyasov I. Z. Venous return and pulmonary hemodynamics during artifi cial ventilation with positive endexpiratory pressure. Med. akad. zhurn. 2019; 19 (3): 11–20. https://doi.org/10.17816/MAJ19311-20 (in russ.).Katira D. H. Ventilator-induced lung injury: Classic and novel concepts. Resp. Care. 2019; 64 (6): 629-637. https://doi.org/10.4187/respcare.07055Katira D. H. Ventilator-induced lung injury: Classic and novel concepts. Resp. Care. 2019; 64 (6): 629-637. https://doi.org/10.4187/respcare.07055Кассиль В. Л., Выжигина М. А., Лескин Г. С. Искусственная и вспомогательная вентиляция легких: Рук. для врачей. М.: Медицина; 2004.Кассиль В. Л., Выжигина М. А., Лескин Г. С. Искусственная и вспомогательная вентиляция легких: Рук. для врачей. М.: Медицина; 2004. [Kassil V. L., Vyzhigina M.A, Leskin G. S. Artifi cial and assisted ventilation: Handbook for physicians. M.: Meditsina; 2004 (in russ.).Levine S., Nguyen T., Taylor N., Friscia M. E. et al. Rapid disuse atrophy of diaphragm fi bers in mechanically ventilated humans. New Engl. J. Med. 2008; 358 (13): 1327–1335. https://doi.org/10.1056/NEJMoa070447Levine S., Nguyen T., Taylor N., Friscia M. E. et al. Rapid disuse atrophy of diaphragm fi bers in mechanically ventilated humans. New Engl. J. Med. 2008; 358 (13): 1327–1335. https://doi.org/10.1056/NEJMoa070447Welvaart W. N., Paul M. A., Stienen G. J., van Hees H. W. et al. Selective diaphragm muscle weakness after contractile inactivity during thoracic surgery. Ann. Surg. 2011; 254 (6): 1044–1049. https://doi.org/10.1097/SLA.0b013e318232e75bWelvaart W. N., Paul M. A., Stienen G. J., van Hees H. W. et al. Selective diaphragm muscle weakness after contractile inactivity during thoracic surgery. Ann. Surg. 2011; 254 (6): 1044–1049. https://doi.org/10.1097/SLA.0b013e318232e75bVassilakopoulos T., Petrof B. J. Ventilator-induced diaphragmatic dysfunction. Amer. J. Resp. Crit. Care Med. 2004; 169 (3): 336–341. https://doi.org/10.1164/rccm.200304-489CPVassilakopoulos T., Petrof B. J. Ventilator-induced diaphragmatic dysfunction. Amer. J. Resp. Crit. Care Med. 2004; 169 (3): 336–341. https://doi.org/10.1164/rccm.200304-489CPBoon A. J., Meiling J. B., Luetmer M. T., Klein C. J., et al. Paradoxical thinning of the diaphragm on ultrasound is a risk factor for requiring non-invasive ventilation in patients with neuromuscular diaphragmatic dysfunction. Muscle Nerve. 2024; 70 (3): 352–359. https://doi.org/10.1002/mus.28194Boon A. J., Meiling J. B., Luetmer M. T., Klein C. J., et al. Paradoxical thinning of the diaphragm on ultrasound is a risk factor for requiring non-invasive ventilation in patients with neuromuscular diaphragmatic dysfunction. Muscle Nerve. 2024; 70 (3): 352–359. https://doi.org/10.1002/mus.28194Jung B., Moury P. H., Mahul M., de Jong A. et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intens. Care Med. 2016; 42 (5): 853–861. https://doi.org/10.1007/s00134-015-4125-2Jung B., Moury P. H., Mahul M., de Jong A. et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intens. Care Med. 2016; 42 (5): 853–861. https://doi.org/10.1007/s00134-015-4125-2Davis R. T., Bruells C. S., Stabley J. N., McCullough D. J. et al. Mechanical ventilation reduces rat diaphragm blood fl ow and impairs oxygen delivery and uptake. Crit. Care Med. 2012; 40 (10): 2858–2866. https://doi.org/10.1097/CCM.0b013e31825b933aDavis R. T., Bruells C. S., Stabley J. N., McCullough D. J. et al. Mechanical ventilation reduces rat diaphragm blood fl ow and impairs oxygen delivery and uptake. Crit. Care Med. 2012; 40 (10): 2858–2866. https://doi.org/10.1097/CCM.0b013e31825b933aPowers S. K., Smuder A. J., Criswell D. S. Mechanistic links between oxidative stress and disuse muscle atrophy. Antioxid. Redox. Signal. 2011; 15 (9): 2519–2528. https://doi.org/10.1089/ars.2011.3973Powers S. K., Smuder A. J., Criswell D. S. Mechanistic links between oxidative stress and disuse muscle atrophy. Antioxid. Redox. Signal. 2011; 15 (9): 2519–2528. https://doi.org/10.1089/ars.2011.3973Hermans G., van den Berghe G. Clinical review: Intensive care unit asquired weakness. Crit. Care. 2015; 19 (1): 274. https://doi.org/10.1186/s13054-015-0993-7Hermans G., van den Berghe G. Clinical review: Intensive care unit asquired weakness. Crit. Care. 2015; 19 (1): 274. https://doi.org/10.1186/s13054-015-0993-7Powers S. K., Wiggs M. P., Sollanek K. J., Smuder A. J. Ventilator-induced diaphragm dysfunction: cause and effect. Amer. J. Physiol. Regul. Integr. Comp. Physiol. 2013; 305 (5): R464–R477. https://doi.org/10.1152/ajpregu.00231.2013Powers S. K., Wiggs M. P., Sollanek K. J., Smuder A. J. Ventilator-induced diaphragm dysfunction: cause and effect. Amer. J. Physiol. Regul. Integr. Comp. Physiol. 2013; 305 (5): R464–R477. https://doi.org/10.1152/ajpregu.00231.2013Беляев А. Ф., Харьковская Т. С., Фотина О. Н., Юрченко А. А. Влияние остеопатической коррекции на функцию внешнего дыхания у пациентов, перенесших коронавирусную пневмонию COVID-19. Рос. остеопат. журн. 2021; 4: 8–17. https://doi.org/10.32885/2220-0975-2021-4-8-17Belyaev A. F., Kharkovskaya T. S., Fotina O. N., Yurchenko A. A. Effect of osteopathic correction on the function of external respiration in patients with COVID-19 coronavirus pneumonia. Russ. Osteopath. J. 2021; 4: 8–17. https://doi.org/10.32885/2220-0975-2021-4-8-17 (in russ.).Doorduin J., van Hees H. W., van der Hoeven J. G., Heunks L. M. Monitoring of the respiratory muscles in the critically ill. Amer. J. Resp. crit. Care Med. 2013; 187 (1): 20–27. https://doi.org/10.1164/rccm.201206-1117CPDoorduin J., van Hees H. W., van der Hoeven J. G., Heunks L. M. Monitoring of the respiratory muscles in the critically ill. Amer. J. Resp. crit. Care Med. 2013; 187 (1): 20–27. https://doi.org/10.1164/rccm.201206-1117CPRafferty G. F., Greenough A., Manczur T., Polkey M. I. et al. Magnetic phrenic nerve stimulation to assess diaphragm function in children following liver transplantation. Pediat. crit. Care Med. 2001; 2 (2): 122–126. https://doi.org/10.1097/00130478-200104000-00005Rafferty G. F., Greenough A., Manczur T., Polkey M. I. et al. Magnetic phrenic nerve stimulation to assess diaphragm function in children following liver transplantation. Pediat. crit. Care Med. 2001; 2 (2): 122–126. https://doi.org/10.1097/00130478-200104000-00005Yonis H., Crognier I., Conil J-M., Serres I. et al. Patient-ventilator synchrony in Neurally Ajusted Ventilatory Assist (NAVA) and Pressure Support Ventilation (PSV): A prospective observational study. BMC Anesthesiol. 2015; 15: 117. https://doi.org/10.1186/s12871-015-0091-zYonis H., Crognier I., Conil J-M., Serres I. et al. Patient-ventilator synchrony in Neurally Ajusted Ventilatory Assist (NAVA) and Pressure Support Ventilation (PSV): A prospective observational study. BMC Anesthesiol. 2015; 15: 117. https://doi.org/10.1186/s12871-015-0091-zDiNino E., Gartman E. J., Sethi J. M., McCool E. D. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014; 69 (5): 423–427. https://doi.org/10.1136/thoraxjnl-2013-204111DiNino E., Gartman E. J., Sethi J. M., McCool E. D. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014; 69 (5): 423–427. https://doi.org/10.1136/thoraxjnl-2013-204111Courtney R. The functions of breathing and its dysfunctions and their relationship to breathing therapy. Int. J. Osteopath. Med. 2009; 12 (3): 78–85. https://doi.org/10.1016/j.ijosm.2009.04.002Courtney R. The functions of breathing and its dysfunctions and their relationship to breathing therapy. Int. J. Osteopath. Med. 2009; 12 (3): 78–85. https://doi.org/10.1016/j.ijosm.2009.04.002Hruby R. J. The rib cage. In, Foundations for osteopathic medicine; Ward RC (2nd ed.). London, Lippincott Williams & Wilkins; 2003: 719–720.Hruby R. J. The rib cage. In, Foundations for osteopathic medicine; Ward RC (2nd ed.). London, Lippincott Williams & Wilkins; 2003: 719–720.Мохов Д. Е., Аптекарь И. А., Белаш В. О., Литвинов И. А., Могельницкий А. С., Потехина Ю. П., Тарасов Н. А., Тарасова В. В., Трегубова Е. С., Устинов А. В. Основы остеопатии: Учебник / Под ред. Д. Е. Мохова. М.: ГЕОТАР-Медиа; 2020.Mokhov D. E., Aptekar I. A., Belash V. O., Litvinov I. A., Mogelnitskiy A. S., Potekhina Yu. P., Tarasov N. A., Tarasova V. V., Tregubova E. S., Ustinov A. V. Fundamentals of osteopathy: A textbook / D. E. Mokhov (eds.) M.: GEOTAR-Media; 2020 (in russ.).Завертайло Л. Л., Ермаков Е. А., Семенькова Г. В., Мальков О. А. и др. Прекращение длительной искусственной вентиляции легких (обзор литературы). Интенсивная терапия. 2007; 3: 66–79.Zavertailo L. L., Ermakov E. A., Semenkova G. V., Malkov O. A. et al. Termination of prolonged mechanical ventilation (literature review). Intens. Care. 2007; 3: 66–79 (in russ.).Jones C., Skirrow P., Griffi ths R., Humphris G. et al. Rehabilitation after critical illness: A randomized, controlled trial. Crit. Care med. 2003; 31: 2456–2461. https://doi.org/10.1097/01.CCM.0000089938.56725.33Jones C., Skirrow P., Griffi ths R., Humphris G. et al. Rehabilitation after critical illness: A randomized, controlled trial. Crit. Care med. 2003; 31: 2456–2461. https://doi.org/10.1097/01.CCM.0000089938.56725.33Chuang M. L., Chou Y. L., Lee C. Y., Huang S. F. Instantaneous responses the hight-frequency chest wall oscillation in patients with acute pneumonie respiratory failure receiving mechanical ventilation: A randomized controlled study. Medicine (Baltimore). 2017; 96 (9): e5912. https://doi.org/10.1097/MD.0000000000005912Chuang M. L., Chou Y. L., Lee C. Y., Huang S. F. Instantaneous responses the hight-frequency chest wall oscillation in patients with acute pneumonie respiratory failure receiving mechanical ventilation: A randomized controlled study. Medicine (Baltimore). 2017; 96 (9): e5912. https://doi.org/10.1097/MD.0000000000005912Onders R., Markovitz A., Ho V. P., Hardacre J. et al. Completed FDA feasibility trial of surgical placed temporary diaphragm pacing electrodes: A promising option to prevent and treat respiratory failure. Amer. J. Surg. 2018; 215 (3): 518–521. https://doi.org/j.amsurg.2017.10.054Onders R., Markovitz A., Ho V. P., Hardacre J. et al. Completed FDA feasibility trial of surgical placed temporary diaphragm pacing electrodes: A promising option to prevent and treat respiratory failure. Amer. J. Surg. 2018; 215 (3): 518–521. https://doi.org/j.amsurg.2017.10.054Паромов К. В., Свирский Д. А., Киров М. Ю. Лечение дисфункции диафрагмы в послеоперационном периоде кардиохирургического вмешательства: обзор литературы и клинический случай. Вестн. интенсив. тер. им. А. И. Салтанова. 2022; 3: 57–68. https://doi.org/10.21320/1818-474X-2022-3-57-68Paromov K. V., Svirskiy D. A., Kirov M.Yu. Treatment option for diaphragm dysfunction after cardiac surgery: A review and a clinical case. Bull. crit. Care. 2022; 3: 57–68. https://doi.org/10.21320/1818-474X-2022-3-57-68 (in russ.).Hollie B. Osteopathic management of patients with breathing dysfunction: An exploratory study. Osteopath. Res. Web. https://www.osteopathicresearch.org/s/orw/item/1796Hollie B. Osteopathic management of patients with breathing dysfunction: An exploratory study. Osteopath. Res. Web. https://www.osteopathicresearch.org/s/orw/item/1796Auer-Rizzi K. Breathing and the Center of Command — the infl uence of respiration on the Central Nervous System. Osteopath. Res. Web.Auer-Rizzi K. Breathing and the Center of Command — the infl uence of respiration on the Central Nervous System. Osteopath. Res. Web.Rocha T., Souza H., Brandão D. C., Rattes C. et al. The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: A randomised trial. J. Physiother. 2015; 61 (4): 182–189. https://doi.org/10.1016/j.jphys.2015.08.009Rocha T., Souza H., Brandão D. C., Rattes C. et al. The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: A randomised trial. J. Physiother. 2015; 61 (4): 182–189. https://doi.org/10.1016/j.jphys.2015.08.009González-Álvarez F., Valenza M., Cabrera-Martos I., Torres Sánchez I. et al. Effects of a diaphragm stretching technique on pulmonary function in healthy participants: A randomized-controlled trial. Int. J. Osteopath. Med. 2014; 18 (1): 5–12. https://doi.org/10.1016/j.ijosm.2014.08.001González-Álvarez F., Valenza M., Cabrera-Martos I., Torres Sánchez I. et al. Effects of a diaphragm stretching technique on pulmonary function in healthy participants: A randomized-controlled trial. Int. J. Osteopath. Med. 2014; 18 (1): 5–12. https://doi.org/10.1016/j.ijosm.2014.08.001Noll D. R., Degenhardt B. F., Johnson J. C. Multicenter osteopathic pneumonia study in the elderly: Subgroup analysis on hospital length of stay, ventilator-dependent respiratory failure rate, and in-hospital mortality rate. J. Amer. Osteopath. Ass. 2016; 116 (9): 574–587.Noll D. R., Degenhardt B. F., Johnson J. C. Multicenter osteopathic pneumonia study in the elderly: Subgroup analysis on hospital length of stay, ventilator-dependent respiratory failure rate, and in-hospital mortality rate. J. Amer. Osteopath. Ass. 2016; 116 (9): 574–587.Nair A., Alaparthi G. K., Krishnan S., Rai S. et al. Comparison of diaphragmatic stretch technique and manual diaphragm release technique on diaphragmatic excursion in chronic obstructive pulmonary disease: A randomized crossover trial. Pulm. Med. 2019; 2019: 6364376. https://doi.org/10.1155/2019/6364376Nair A., Alaparthi G. K., Krishnan S., Rai S. et al. Comparison of diaphragmatic stretch technique and manual diaphragm release technique on diaphragmatic excursion in chronic obstructive pulmonary disease: A randomized crossover trial. Pulm. Med. 2019; 2019: 6364376. https://doi.org/10.1155/2019/6364376Ritambhara Y., Tarun K., Dr. Jeyanthi. S. Effect of manual diaphragm release technique on transversus abdominis activation, pulmonary function and chest expansion — a randomized control trial. Int. J. All Res. Educat. Sci. Methods. 2024; 12 (7): 2108–2112. https://doi.org/10.56025/IJARESM.2024.1207242108.Ritambhara Y., Tarun K., Dr. Jeyanthi. S. Effect of manual diaphragm release technique on transversus abdominis activation, pulmonary function and chest expansion — a randomized control trial. Int. J. All Res. Educat. Sci. Methods. 2024; 12 (7): 2108–2112. https://doi.org/10.56025/IJARESM.2024.1207242108.Hosking S. W. The effect of osteopathic manipulative techniques on diaphragm movement and respiratory function in asymptomatic subjects; 2009. https://www.researchbank.ac.nz/server/api/core/bitstreams/43fc15bf-531e-4db0-978cab1a091e75d5/contentHosking S. W. The effect of osteopathic manipulative techniques on diaphragm movement and respiratory function in asymptomatic subjects; 2009. https://www.researchbank.ac.nz/server/api/core/bitstreams/43fc15bf-531e-4db0-978cab1a091e75d5/contentAllen T. W., D′Alonzo G. E. Investigating the role of osteopathic manipulation in the treatment of asthma. J. Amer. Osteopath. Ass. 1993; 93 (6): 654–656.Allen T. W., D′Alonzo G. E. Investigating the role of osteopathic manipulation in the treatment of asthma. J. Amer. Osteopath. Ass. 1993; 93 (6): 654–656.Yao S., Hassani J., Gagne M., George G. et al. Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia. J. Vis. Exp. 2014; (87): e50687. https://doi.org/10.3791/50687Yao S., Hassani J., Gagne M., George G. et al. Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia. J. Vis. Exp. 2014; (87): e50687. https://doi.org/10.3791/50687

The authors declare that there are no conflicts of interest present.