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Phrenic nerve dysfunction after heart-lung and lung transplantation.
P Ferdinande1, F Bruyninckx, D Van Raemdonck
1Department of Intensive Care Medicine, University Hospital Gasthuisberg, Leuven, Belgium. patrick.ferdinande@kuleuven.ac.be
Summary
Phrenic nerve dysfunction (PND) is common after heart-lung and lung transplants, significantly increasing ventilator days and ICU stays. Early detection and management are crucial for patient outcomes.
Area of Science:
- Cardiothoracic Surgery
- Pulmonary Medicine
- Neurosurgery
Background:
- Phrenic nerve dysfunction (PND) is a known complication post-cardiac surgery.
- Limited data exists on PND incidence and outcomes following heart-lung (HLTx) and lung transplantation (LTx).
Purpose of the Study:
- To determine the incidence and consequences of PND after HLTx and LTx.
- To assess the impact of PND on ventilator days and intensive care unit (ICU) length of stay (LOS).
Main Methods:
- Retrospective chart review of 27 HLTx and 111 LTx recipients (1991-2001).
- Clinical suspicion of diaphragmatic dysfunction prompted nerve conduction studies.
- Needle electromyogram (EMG) of the diaphragm was used for non-conclusive conduction studies.
Main Results:
- PND incidence was 42.8% in HLTx and 9.3% in LTx recipients.
- PND significantly increased ventilator days and ICU LOS in both HLTx and LTx groups (p < 0.05).
- LTx patients with PND required more tracheostomies (44.4% vs 4.5%, p < 0.005).
Conclusions:
- PND is a significant clinical issue after HLTx and LTx.
- PND substantially impacts ventilator duration and ICU resource utilization.
- Further research into PND management post-transplant is warranted.