Respiratory Function after Paralysis of the Right Hemidiaphragm¹

Abstract

We studied a 45-yr-old man with normal lung function before and 7 wk after right phrenic nerve crush. Total lung capacity, functional residual capacity, and forced vital capacity decreased with residual volume remaining unchanged. Static compliance was also unchanged. Ventilatory response to CO2 (delta Ve/delta PaCO2) was preserved, but P0.1 response to CO2 (delta P0.1/delta PaCO2) increased. Analysis of raw mouth pressure suggested that these responses were the result of a new rapid pattern of inspiratory pressure development. Regional washout was slowed on the side with paralysis, but the normal apex-to-base gradient of regional volumes was preserved. Inhaled 133Xe boluses were distributed away from the side of paralysis, and bolus distribution changed relatively little with increased flow. These results suggested that in compensation for paralysis of a hemidiaphragm, a new pattern of inspiratory muscle recruitment developed, involving more rapid contraction of the remaining muscles of inspiration.

Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function

“…Significant reduction of pulmonary function has been reported, however, after accidental right phrenic nerve injury, 1 during thoracic tumor surgery, 19 and in a nerve crush for intractable hiccups. 2 In contrast with these observations, patients in our study were young and their preoperative pulmonary function was not compromised, because patients with previous lung contusions were excluded.…”

Nocturnal Hypoxia in Unilateral Diaphragmatic Paralysis

“…There are reduc tions in ventilation and perfusion of the lower lobe on the affected side leading to some mismatching and widening of alveolar-arterial oxygen difference and mild hypoxemia. These findings deteriorate in the su pine position [1][2][3]. Arterial oxygen tension is signifi cantly below normal in the supine position but often in the normal range in the sitting position.…”

Reinnervation aspects of laryngeal transplantation

“…The sacrifice of one PN is usually considered to be acceptable [4,5,7,16], although additional respiratory disturbances might be expected in some patients with pre-existing lung disease, such as found in patients with chronic obstructive pulmonary disorders.…”