Caffeine Expectancy Does Not Affect Interval Running Performance, Physiological Responses, or Running Kinematics in Trained Runners: A Randomized Controlled Crossover Trial.

Mechanical ventilation (MV) is a cornerstone of supportive care in the intensive care unit (ICU), yet it frequently induces rapid diaphragmatic atrophy and contractile dysfunction, collectively termed ventilator-induced diaphragm dysfunction (VIDD) (). The principal features include diaphragmatic atrophy, sarcomeric injury, decreased contractile force, impaired endurance, and reduced excursion (). VIDD is one of the major contributors to weaning failure (). The reported incidence of diaphragmatic dysfunction (DD) in mechanically ventilated patients ranges from 60 to 80% (), rising to as high as 80% in critically ill patients with prolonged intubation (). DD progresses rapidly: diaphragm thickness decreases by approximately 9, 20, and 26% within 24, 48, and 72 h of MV, respectively (). Its consequences include impaired respiratory function, ventilator dependence, ventilator-associated pneumonia (VAP), weaning failure, prolonged hospitalisation, and increased healthcare costs (). The pathophysiology of VIDD involves diaphragmatic disuse, oxidative stress, and activation of proteolytic pathways (, ). Despite this mechanistic understanding, the clinical risk factors for DD have not been systematically characterised. Available evidence implicates MV duration, ventilation mode, sedation depth, and sepsis (), but the underlying studies are predominantly single-centre with small samples and inconsistent findings. A comprehensive, quantitative synthesis is lacking. The present systematic review and meta-analysis was therefore conducted to identify and quantify risk factors for DD in mechanically ventilated patients, with the aim of informing clinical risk stratification and preventive strategies. The study was registered on PROSPERO (CRD420261302793). Case–control studies, cohort studies, and cross-sectional studies were eligible for inclusion.