Non-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery

Abstract

We present the case histories of two children having respiratory failure due to bilateral diaphragm paralysis after cardiac surgery. In both children non-invasive positive pressure ventilation alleviated respiratory distress, improved gas exchange, and prevented the need for endotracheal intubation. Following unilateral recovery of diaphragmatic function both children were successfully weaned from non-invasive positive pressure ventilation.

Bilateral Diaphragmatic Paralysis Following Paediatric Cardiac Surgery: Experience of four cases at the Royal Hospital, Muscat, Oman

“…In addition, the oronasal mask did not fit properly and there was leakage from the nasopharyngeal tube. 5 In the present case series, accidental decannulation of the tracheostomy tube without loss of airway occurred in one patient; however, there were no other major complications and all of the patients survived. Four episodes of lower respiratory tract infection were observed, with three of them arising in the patient with prolonged chylothorax due to immunoglobulin loss.…”

“…12,13 In cases of BDP, ultrasonography and/or fluoroscopy findings are considered diagnostic. 5,9,10,[15][16][17][18] All BDP diagnoses in the current series were based on one of these radiological modalities. Imaging was performed following failed extubation attempts or the development of severe respiratory distress soon after extubation and was repeated before the tracheostomy to confirm the diagnosis and to make sure that no early diaphragm recovery had occurred.…”

“…19 Kovacikova et al described two patients in which noninvasive positive pressure ventilation was used to manage respiratory failure resulting from BDP; the first patient was fitted with a nasopharyngeal tube and the second with an anesthaesia oronasal mask, with both patients requiring ventilation pressure control. 5 Although the treatment was noninvasive, complications were reported such as pressure sores over the nasal bridge and cheeks and secondary herpetic and chest infections. In addition, the oronasal mask did not fit properly and there was leakage from the nasopharyngeal tube.…”

“…As such, BDP almost always requires prompt ventilation using an endotracheal tube, tracheostomy or noninvasive mechanical ventilation (MV). 5 This case series describes the management of four paediatric patients with BDP, emphasising the importance of conservative management until the diaphragm recovers, expected recovery time and the safety of an interventional tracheostomy in such cases.…”

Diaphragmatic Paralysis Following Congenital Cardiac Surgery-A Single Center Experience

“…But it was notable that all these patients had developed ventilator associated pneumonia. Use of noninvasive ventilatory assistance also has been reported as an alternative treatment of bilateral diaphragmatic paralysis in infants to avoid tracheostomy or long term endotracheal intubation (20,21) Limitations This study is limited by its retrospective nature. There is no control group of patients who were managed without surgical intervention in order to have a true comparison to find out the effectiveness of plication.…”