Phrenic Nerve Dysfunction After Cardiac Operations

Dimopoulou, Ioanna; Daganou, Maria; Dafni, Urania; Karakatsani, Anna; Khoury, Mazen; Geroulanos, S; Jordanoglou, J.

doi:10.1378/chest.113.1.8

Cited by 101 publications

(22 citation statements)

References 25 publications

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“…As the phrenic nerve is located very close to the heart, cold cardioplegia used during cardiac bypass will cause phrenic nerve cold injury called phrenic nerve frostbite and lead to impaired conduction on impulses. Due to the long course of the left phrenic nerve in the thorax, left-side diaphragmatic weakness is more common compared to right side [ 5 , 6 , 7 , 8 , 9 , 10 ]. Any mediastinal procedures, esophageal surgeries or lung transplantation carry the risk of phrenic nerve injury and diaphragmatic weakness [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Diaphragmatic Palsy (Dp)mentioning

confidence: 99%

Diaphragmatic Palsy

Kokatnur

Rudrappa

2018

Diseases

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The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy. Diaphragmatic movements with respiration can be directly visualized by fluoroscopic examination. Currently, this test is being replaced by bedside thoracic ultrasound examination, looking at the diaphragmic excursion with deep breathing or sniffing. This test is found to be equally efficient, and without risks of ionizing radiation of fluoroscope. Treatment of diaphragmatic palsy depends on the cause. Surgical approach of repair of diaphragm or nonsurgical approach of noninvasive ventilation has been tried with good success. Overall prognosis of diaphragmatic palsy is good, except when it is related to neuromuscular degeneration conditions.

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Section: Diaphragmatic Palsy (Dp)mentioning

confidence: 99%

Diaphragmatic Palsy

Kokatnur

Rudrappa

2018

Diseases

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“…In particular, coronary artery bypass grafting (CABG) surgery is frequently associated with lesions of the phrenic nerves resulting in post-operative diaphragmatic paralysis, with incidences reported as varying from 1% to 60% [7,8,9,10,11]. One of the reasons for this wide estimate probably lies in the various surgical techniques used during CABG: harvesting of the internal mammary artery (IMA) and the use of topical ice slush for cardiac cooling are associated with an increased risk of phrenic injury [7,9,10,11,12,13,14], the former because of the close anatomical relationship of the nerve and the IMA and the latter because of the traumatic demyelinating injury to the phrenic nerved induced by the cold temperature. …”

Section: Etiology Of Diaphragmatic Dysfunctionmentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

144

109

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The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.

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“…Respiratory complications are frequent after cardiac surgery, and they have been related to diaphragm paresis [1–3]. Diaphragm paresis incidence depends mainly on surgical technique and is associated with delayed weaning from mechanical ventilation [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study

Moury

Cuisinier

Durand

et al. 2019

Ann. Intensive Care

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Background Diaphragm paresis is common after cardiac surgery and may delay the weaning from the ventilator. Our objective was to evaluate diaphragm thickening during weaning and secondly the muscle thickness as a marker of myotrauma. Methods Patients undergoing elective cardiac surgery were prospectively included. Ultrasonic index of right hemidiaphragm thickening fraction (TF) was measured as a surrogate criterion of work of breathing. A TF < 20% was defined as a low diaphragm thickening. Measurements of TF were performed during three periods to study diaphragm thickening evolution defined by the difference between two consecutive time line point: preoperative ( D − 1), during a spontaneous breathing trial (SBT) in the intensive care unit and postoperative ( D + 1). We studied three patterns of diaphragm thickness at end expiration evolution from D − 1 to D + 1: > 10% decrease, stability and > 10% increase. Demographical data, length of surgery, type of surgery, ICU length of stay (LOS) and extubation failure were collected. Results Of the 100 consecutively included patients, 75 patients had a low diaphragm thickening during SBT. Compared to TF values at D − 1 (36% ± 18), TF was reduced during SBT (17% ± 14) and D + 1 (12% ± 11) ( P < 0.0001). Thickness and TF did not change according to the type of surgery or cooling method. TF at SBT was correlated to the length of surgery (both r = − 0.4; P < 0.0001). Diaphragm thickness as continuous variable did not change over time. Twenty-eight patients (42%) had a > 10% decrease thickness, 19 patients (29%) stability and 19 patients (28%) in > 10% increase, and this thickness evolution pattern was associated with: a longer LOS 3 days [2–5] versus 2 days [2–4] and 2 days [2], respectively (ANOVA P = 0.046), and diaphragm thickening evolution (ANOVA P = 0.02). Two patients experience extubation failure. Conclusion These findings indicate that diaphragm thickening is frequently decreased after elective cardiac surgery without impact on respiratory outcome, whereas an altered thickness pattern was associated with a longer length of stay in the ICU. Contractile activity influenced thickness evolution. Trial registry number ClinicalTrial.gov ID NCT02208479 Electronic supplementary material The online version of this article (10.1186/s13613-019-0521-z) contains supplementary material, which is available to authorized users.

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Phrenic Nerve Dysfunction After Cardiac Operations

Cited by 101 publications

References 25 publications

Diaphragmatic Palsy

Diaphragmatic Palsy

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Diaphragm thickening in cardiac surgery: a perioperative prospective ultrasound study

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