Respiratory inductance plethysmography used to diagnose bilateral diaphragmatic paralysis: a case report

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Diagnostic Imaging

Background:

• Bilateral diaphragmatic paralysis is a rare condition that can complicate pediatric cardiothoracic surgery.
• Diagnosing diaphragmatic paralysis can be challenging, especially in young children, with conventional methods often proving inconclusive.
• This case report focuses on a 23-month-old child who failed to wean from mechanical ventilation after repeat sternotomies.

Observation:

• Respiratory inductance plethysmography was utilized to evaluate thoracoabdominal synchrony.
• The patient exhibited complete thoracoabdominal asynchrony during spontaneous breathing, characterized by clockwise Konno-Mead loops and phase angles near 180 degrees.
• Esophageal manometry revealed an elevated work of breathing, indicated by a pressure-rate product of 120 cm H(2)O/min.

Findings:

• Respiratory inductance plethysmography effectively identified thoracoabdominal asynchrony, confirming the diagnosis of bilateral diaphragmatic paralysis.
• Continuous positive airway pressure (CPAP) significantly reduced the work of breathing, as evidenced by a dramatic decrease in the pressure-rate product.
• The response to CPAP suggests its potential utility in predicting the success of diaphragmatic plication surgery.

Implications:

• Thoracoabdominal synchrony measurement using respiratory inductance plethysmography is a valuable tool for diagnosing bilateral diaphragmatic paralysis.
• Continuous positive airway pressure can serve a dual role diagnostically and therapeutically, potentially guiding surgical interventions.
• Further controlled trials are warranted to compare thoracoabdominal synchrony measurement with existing diagnostic methods for diaphragmatic paralysis.