Mechanical ventilation (MV) is a life-saving respiratory support therapy, but MV can lead to diaphragm muscle injury (myotrauma) and induce diaphragmatic dysfunction (DD). DD is relevant because it is highly prevalent and associated with significant adverse outcomes, including prolonged ventilation, weaning failures, and mortality. The main mechanisms involved in the occurrence of myotrauma are associated with inadequate MV support in adapting to the patient’s respiratory effort (over- and under-assistance) and as a result of patient-ventilator asynchrony (PVA). The recognition of these mechanisms associated with myotrauma forced the development of myotrauma prevention strategies (MV with diaphragm protection), mainly based on titration of appropriate levels of inspiratory effort (to avoid over- and under-assistance) and to avoid PVA. Protecting the diaphragm during MV therefore requires the use of tools to monitor diaphragmatic effort and detect PVA. Diaphragm ultrasound is a non-invasive technique that can be used to monitor diaphragm function, to assess PVA, and potentially help to define diaphragmatic effort with protective ventilation. This review aims to provide clinicians with an overview of the relevance of DD and the main mechanisms underlying myotrauma, as well as the most current strategies aimed at minimizing the occurrence of myotrauma with special emphasis on the role of ultrasound in monitoring diaphragm function.

Background/Objectives: Cancer is a disabling, challenging, and growing global disease. Although early diagnosis and adequate treatment of cancer are developing rapidly, a large part of the population remains without access to specialized services and routinely progresses to uncontrolled pain, poorer quality of life, and suffering. Complementary therapies for pain management and the well-being of patients under palliative care are fundamental tools of integrative oncological medicine. This first version of the protocol was created in August 2023 to structure the aim of this study to investigate the effectiveness of the experimental protocol which uses immersive virtual reality as a meditation tool in patients followed at the Pain Therapy and Palliative Care Service of the CECON Foundation. Methods: This randomized clinical trial, conducted at the Pain Therapy and Palliative Care Service (STDCP) of the FCECON, explores the use of immersive virtual reality to promote regular meditation practice among cancer patients as an effective means of managing pain and improving quality of life. Discussion: The present study has the potential to evaluate the effectiveness of immersive virtual reality as a meditation tool for patients undergoing palliative care, in addition to contributing scientific evidence that supports better decisions in healthcare for the management of cancer pain. Trial registration: Brazilian Registry of Clinical Trials (ReBEC) and ClinicalTrials.gov/NCT06328751/Universal Trial Number (UTN) U1111-1304-3752.