Peripheral Nerve Injury in Cardiac Surgery

Diaphragm Paralysis After Cardiac Surgery: A Frequent Cause of Post-Operative Respiratory Failure

“…It is uncertain whether phrenic nerve injury is primarily related to direct surgical injury or to ligation of its blood supply during internal mammary artery (IMA) dissection, especially when using electric cautery. Stretching of the phrenic nerves during chest opening may also be a possible mechanism and may explain why BMI, which supposes higher strength to open the chest, was associated with DD in our study and in others [10,27]. The anatomic relationship between the phrenic nerve and the IMA is inconstant, and thus, caution must be taken when dissecting this artery.…”

“…We found 272 cases of DD (7.6%). Individuals with DD had more arterial hypertension (64.3% vs. 52.6%; p<0.0001), higher body mass index (BMI) (28 [25][26][27][28][29][30] kg/m2 vs. 26 [24][25][26][27][28][29] kg/m2; p<0.0002) and higher incidence of coronary bypass grafting (58.8% vs. 46.6%; p=0.0001). DD was associated with more postoperative pneumonia (23.9% vs. 8.7%; p<0.0001), reintubation (8.8% vs. 2.9%; p<0.0001), tracheotomy (3.3% vs. 0.3%; p<0.0001), non-invasive ventilation (45.6% vs. 5.4%; p<0.0001), duration of mechanical ventilation (5 [4][5][6][7][8][9][10][11] h vs. 4 [3][4][5][6] h; p<0.0001), and ICU and hospital stays (14 [11][12][13][14][15][16][17] days vs. 13 [11][12][13][14][15][16] days; p<0.0001).…”

Diaphragmatic Dysfunction FollowingCardiac Surgery: Is There a Role forPulmonary Ultrasound?

“…5,6 The incidence of diaphragmatic dysfunction after cardiac surgery is reported to range from 1% to 60%. 1,7 Despite the variability of these data, we can state that it is a highly frequent condition, with an impact on clinical outcome. The weaning from mechanical ventilation can be challenging in the presence of diaphragmatic dysfunction of any etiology.…”

“…We read with great interest the work from Jellish and Oftadeh about peripheral nerve injury after cardiac surgery. 1 Their article well summarizes the known nerve lesions related to cardiac surgery, together with the pathophysiology and clinical workup. Among the possible iatrogenic lesions, which can affect patients undergoing cardiac surgery, a significant role is played by diaphragmatic dysfunction due to phrenic nerve injury.…”

“…There are some nuances such as sex differences and differences in laterality that should be taken into consideration when interpreting images. 1 However, as they correctly point out, the technique is relatively easy to learn, and the learning curve can be quite steep, particularly with a formal training protocol. 2,3 Ultrasound has been a vital tool for placement of nerve blocks, central line access, A-line placement, and identification of the epidural space for catheter placement.…”