Postoperative phrenic nerve palsy: early clinical implications and management

Abstract

Especially in newborns and young infants with DP the length of mechanical ventilation, ICU stay, and hospital stay are prolonged. Early spontaneous recovery of the phrenic nerve is rare. In cases of respiratory impairment early transthoracic diaphragmatic plication is an effective means of treatment.

Hemidiaphragmatic paralysis in preterm neonates: a rare complication of peripherally inserted central catheter extravasation

“…In the obstetrical context, DP is rarely an isolated finding with most cases associated with an ipsilateral brachial plexus lesion [2]. Diaphragmatic paralysis can also occur after direct phrenic nerve damage during cardiac or thoracic surgery [1,5] central vein catheterization [3,4,6] or chest tube placement [7]. In the 2 cases presented here, punctures for catheters placement were on the arm, far from the phrenic nerve course.…”

“…Early surgery could reduce the duration of mechanical ventilation, incidence of pulmonary infections, and length of hospital stay [1,5]. Moreover, in preterm neonates, invasive ventilation is associated with ventilator-induced lung injury, bronchopulmonary dysplasia, oxygen requirement, and increased risk of retinopathy of prematurity [12].…”

“…Thoracic surgery [1] and traumatic delivery [2] are the main causes of diaphragmatic paralysis (DP) in neonatal period. Nerve injury during central venous catheter insertion can also rarely be responsible for DP in neonatal intensive care.…”

Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery

“…A diaphragm paralysis due to phrenicotomy causes decreases in tidal volume and in dynamic lung compliance, and an increase in the work of breathing due to paradoxical movements of the paralysed diaphragm [5][6][7], which may lead to increases in postoperative morbidity and motility. Diaphragm plication is an acceptable treatment for paediatric patients with life-threatening unilateral diaphragm paralysis [8][9][10], while benefits have also been reported in adult patients with chronic unilateral diaphragm paralysis [1,11]. The purpose of diaphragm plication is to reduce the paradoxical movement by stiffening the diaphragm, leading to more efficient ventilation.…”

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

“…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.…”