Exercise testing in patients with diaphragm paresis

Bonnevie, Tristan; Gravier, Francis‐Edouard; Ducrocq, Agathe; Debeaumont, David; Viacroze, Catherine; Cuvelier, A.; Muir, Jean-François; Tardif, Catherine

doi:10.1016/j.resp.2017.11.006

Cited by 22 publications

(27 citation statements)

References 36 publications

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“…One of the reasons why all patients receiving deep CPB do not develop a diaphragmatic motion abnormality might be the anatomical variations including the predominance of the 5th cervical nerve and presence or absence of an accessory phrenic nerve [ 129 ]. Furthermore, the SCM muscle is the accessory muscle of respiration, which is essential when the diaphragm is weak [ 130 – 132 ]. The deep CPB is known to be largely associated with diaphragmatic paralysis [ 129 ], which, combined with the relaxation of the SCM muscle can lead to worse effects on respiratory function than we have previously known, particularly in patients with clinically significant lung disease or suspected diaphragmatic motion abnormalities [ 133 ].…”

Section: Safety Issues Related To Cervical Plexus Blocksmentioning

confidence: 99%

Cervical plexus block

Kim

Bang

et al. 2018

Korean J Anesthesiol

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Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.

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Section: Safety Issues Related To Cervical Plexus Blocksmentioning

confidence: 99%

Cervical plexus block

Kim

Bang

et al. 2018

Korean J Anesthesiol

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“…A fractured and instable clavicle as the origin of the accessory inspiratory muscles (M. sternocleidomastoideus, Mm. scaleni, M. pectoralis) can cause an ineffective respiration and oxygenation [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…This might be attributed to either direct functional de ciency or as a consequence of associated pain [15], especially since the breathing mechanism doesn't only consist of the chest wall itself and the diaphragm. An intact and stable clavicle, as the origin of the accessory inspiratory muscles, is a crucial prerequisite for effective respiration and oxygenation [16,17].…”

Section: Introductionmentioning

confidence: 99%

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

Eberbach

Lefering

Hager³

et al. 2020

Preprint

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Introduction: Thoracic trauma has decisive influence on the outcome of multiply-injured patients and is often associated with clavicle fractures. The affected patients are prone to lung dysfunction and multiple organ failure. The aim of this study is to investigate the influence of surgical stabilization of clavicle fractures in patients with thoracic trauma on specific outcome parameters.Methods: A multi-center, retrospective analysis of patient records documented in the TraumaRegister DGU® between 2009 and 2015 was performed. The inclusion criteria were multiply-injured patients with thoracic trauma and associated clavicle fracture, maximum AIS severity ≥ 3 and admission to the intensive care unit. The influence of operative vs. non-operative clavicular fracture treatment and timing of surgery on lung failure, multiple organ failure, sepsis, length of ICU stay, intubation time and length of hospital stay was assessed by regression analysis.Results: A total of 3,209 patients were included in the analysis. In 1,362 patients (42%) the clavicle fracture was treated operatively after 7.1 ± 5.3 days. Surgically treated patients had a significant reduction in lung failure (p = 0.013, OR = 0.74), multiple organ failure (p = 0.001, OR = 0.64), intubation time (p = 0.004; -1.81 days) and length of hospital stay (p = 0.014; -1.51 days) compared to non-operative treatment. Moreover, surgical fixation of the clavicle within five days following hospital admission significantly reduced the rates of lung failure (p = 0.01, OR = 0.62), multiple organ failure (p = 0.01, OR = 0.59) and length of hospital stay (p = 0.01; -2.1 days).Conclusions: Based on our results, multiply-injured patients with thoracic trauma and concomitant clavicle fracture seem to benefit significantly from surgical stabilization of a clavicle fracture, especially when surgery is performed within the first five days after hospital admission.

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“…This dysfunction ranges from a partial loss of the ability to generate pressure due to muscle weakness to a full loss of diaphragmatic function due to palsy thereof [14]. Unilateral involvement of this muscle is usually paucisymptomatic [15], and may be an underdiagnosed cause of dyspnoea. On the contrary, the bilateral lesion leads to significant dyspnoea at rest, in particular in a lying-down-on-the-back (supine) position [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

2020

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Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods: A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. Results: An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cutoff point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). Conclusions: There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.

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Exercise testing in patients with diaphragm paresis

Cited by 22 publications

References 36 publications

Cervical plexus block

Cervical plexus block

Surgical Stabilization of Clavicle Fractures Reduces Organ Failure Rates in Multiply-injured Patients with Thoracic Trauma: An Analysis Based on the TraumaRegister DGU®.

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

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