Aggressive Treatment of Acquired Phrenic Nerve Paralysis in Infants and Small Children

Shoemaker, Robert C.; Palmer, George J.; Brown, John W.; King, Harold

doi:10.1016/s0003-4975(10)61047-8

Cited by 68 publications

(42 citation statements)

References 11 publications

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“…There have been few reports on phrenic nerve repair with recuperation of function; 19,29 in our case we describe the indication for time of repair, the use of microsurgical techniques, and the excellent result obtained.…”

Section: Discussionmentioning

confidence: 68%

Treatment of chronic ventilatory failure using a diaphragmatic pacemaker

et al. 1998

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We present our series of patients with chronic ventilatory failure treated with electrophrenic respiration: 13 males and nine females with a mean age of 12+11.5 years. The etiology was, 13 tetraplegia, ®ve sequelae of surgical treatment of intracranial lesions, and four central alveolar hypoventilation. The mean duration of the conditioning period were 3 ± 4 months. Eighteen patients (81.8%) achieved permanent, diaphragmatically-paced breathing with bilateral stimulation and in four (18.2%) patients, pacing was only during sleep. Five patients died (22.7%): two during the hospital stay and three at home; two deaths had unknown cause and three were due respectively to, lack of at-home care, recurrence of an epidermoid tumor, and sequelae of accidental disconnection of the mechanical ventilation before beginning the conditioning period. Two cases were considered failures: One patient had transitory neurapraxia lasting 80 days, and the other had an ischemic spinal cord syndrome with progressive deterioration of the left-side response to stimulation. One patient had right phrenic nerve entrapment by scar tissue and four suered infections. The follow-up periods since pacemaker implantation are currently: 1, 11 years; 4, 10 years, and 17, less than 5 years. The results of our experience demonstrate that complete stable ventilation can be achieved using diaphragmatic pacing and that it improves the prognosis and life quality of patients with severe chronic respiratory failure.

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Section: Discussionmentioning

confidence: 68%

Treatment of chronic ventilatory failure using a diaphragmatic pacemaker

et al. 1998

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“…Respiratory condition is one of the most important factors influencing mortality and morbidity especially in infants. DP after cardiac surgery is an important complication with negative effects on pulmonary situation [1][2][3][4][5][6][7][8][9]. Reports of the prevalence of DP after cardiac operations in children vary from 0.3 to 12.8% [3, 6, 10-12, 16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Older children usually have the advantage of handling with diaphragm paralysis as they use their intercostal muscles for respiration when compared with infants [6,9]. Infants have a more horizontally oriented rib cage and their intercostal muscles are weaker.…”

Section: Discussionmentioning

confidence: 99%

“…Diaphragmatic paralysis (DP) due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency, lung infections, prolonged hospital stay time and even death [1][2][3][4][5][6][7][8][9]. It is accepted that procedures in congenital cardiac surgery are the major causes of DP with an incidence ranging from 0.3 to 12.8% [2,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…This situation is the major cause of lung infections and related complications such as atelectasis and recurrent pneumonia [3][4][5]. Great majority of older children have the advantage of overcoming DP as they use their intercostal muscles for respiration when compared with infants [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

et al. 2006

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Diaphragmatic paralysis (DP) after cardiac surgery is an important complication especially in infants. We analyzed the incidence, clinical course, surgical management and follow up of the patients with DP, retrospectively. Between 1996 and 2005, 3,071 patients underwent cardiac surgery. Total number of patients with DP was 152 (4.9%). Out of 152 patients, 42 were surgically treated with transthoracic diaphragm plication (1.3%). The overall incidence of diaphragm paralysis was higher in correction of tetralogy of Fallot (31.5%), Blaloc-Taussig (B-T) shunt (11.1%) and VSD closure with pulmonary artery patch plasty (11.1). The incidence of DP which require plication was higher in B-T shunt (23.8%) arterial switch (19%) and correction of tetralogy of Fallot (11.9%). Mean and median age at the time of surgery were 17.8 +/- 3.6 and 6 months, respectively. Median time from cardiac surgery to surgical plication was 12 days. Indications for plication were repeated reintubations (n = 22), failure to wean from ventilator (n = 12), recurrent lung infections (n = 5) and persistent respiratory distress (n = 3). Mortality rate was 19.1%. Being under 1 year of age, pneumonia and plication 10 days after mechanical ventilation were associated with higher incidence mortality (P < 0.05). Phrenic nerve injury is a serious complication of cardiac surgery. It is more common after some special procedures. Spontaneous recovery is very rare. Being under 1 year of age, plication after 10 days from the surgery and pneumonia are major risk factors for mortality even in plicated patients. Transthoracic plication is helpful if performed early.

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Diaphragmatic Palsy

Bernet¹

2014

Pediatric and Neonatal Mechanical Ventilation

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Aggressive Treatment of Acquired Phrenic Nerve Paralysis in Infants and Small Children

Cited by 68 publications

References 11 publications

Treatment of chronic ventilatory failure using a diaphragmatic pacemaker

Treatment of chronic ventilatory failure using a diaphragmatic pacemaker

Diaphragmatic paralysis after cardiac surgery in children: incidence, prognosis and surgical management

Diaphragmatic Palsy

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