Diaphragm Paralysis

Abstract

The diaphragm is a chief muscle of inspiration. Its paralysis can lead to dyspnea and can affect ventilatory function. Diaphragmatic paralysis can be unilateral or bilateral. The clinical symptoms are more prominent in bilateral diaphragm paralysis. Ventilatory failure and cor pulmonale are usually seen in severe cases. Although an uncommon cause of dyspnea it still remains an underdiagnosed condition. A restrictive process is seen on pulmonary function tests in diaphragm paralysis. The symptoms, oxygenation and vital capacity, usually worsen in supine posture. The diagnoses is usually suspected on chest x-ray and clinical exam and confirmed with sniff test or phrenic nerve stimulation/diaphragm electromyography. In most unilateral cases no treatment is needed, especially in the absence of underlying lung disease. In more severe cases modalities such as diaphragmatic pacing or plication of the diaphragm can be used. In bilateral diaphragm paralysis or in patients with ventilatory failure continuous positive airway pressure or mechanical ventilation and tracheostomy are generally needed. Prognosis is good in unilateral paralysis, especially in the absence of underlying neurological or pulmonary process. Prognosis is usually poor in patients with advanced lung disease, bilateral paralysis, and chronic demyelinating conditions.

Comparison of Mid-Term Clinical Outcomes of Different Surgical Approaches in Symptomatic Diaphragmatic Eventration

“…[3][4][5][6] Same correction mechanism is found to be vital and life-saving in ventilatory dependent patients with uni/bilateral phrenic nerve paralysis. 2,[11][12][13][14] There are several surgical plication techniques described in literature, mainly differing by incising the diaphragm or not. The accordion and the double-breasted plication techniques are the most common transthoracic approaches used by thoracic surgeons aiming to achieve a tense and tight diaphragm.…”

Phrenic-Recurrent Nerve Anastomosis in Animal Models with Unilateral Cutting of the Recurrent Nerve

“…The major physiologic function of the diaphragm is ventilation [4]. Prognosis is good in unilateral paralysis, especially in the absence of underlying neurological or pulmonary process [5]. Paralysis of the right or left hemidiaphragms does not significantly affect respiratory function.…”

Pathophysiologische Bedeutung des Schlafs bei Zwerchfelllähmung und anderen neuromuskulären Erkrankungen

“…Auch die FEV 1 -Werte sind erniedrigt und liegen bei einseitiger Zwerchfellparese bei 70%, bei beidseitiger Parese bei 50%. Die totale Lungenkapazität (TLC), die funktionelle Residualkapazität (FRC) und das Residualvolumen (RV) sind in der Regel nur bei beidseitigen Paresen verändert [23].…”