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Functional and Morphological Assessment of Diaphragm Innervation by Phrenic Motor Neurons
Published on: May 25, 2015
Postoperative phrenic nerve palsy: early clinical implications and management
Julia Lemmer1, Brigitte Stiller, Grit Heise
1Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. lemmer@dhzb.de
Intensive Care Medicine
|June 3, 2006
Summary
Diaphragmatic palsy (DP) after cardiothoracic surgery prolongs hospital stays and ventilation. Surgical diaphragmatic plication is effective for respiratory issues, especially in infants, as phrenic nerve recovery is rare.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Phrenic nerve injury can lead to diaphragmatic palsy (DP) in children post-cardiothoracic surgery.
- DP impacts patient morbidity, including prolonged ventilation and hospital stays.
- The potential for spontaneous phrenic nerve regeneration is a key consideration.
Purpose of the Study:
- To assess the clinical impact of diaphragmatic palsy (DP) following pediatric cardiothoracic surgery.
- To evaluate the effects of DP on morbidity, mortality, and phrenic nerve regeneration.
- To determine the efficacy of surgical diaphragmatic plication in managing DP.
Main Methods:
- Retrospective case-control study of 74 children with DP and 74 matched controls.
- Analysis of data from 5,128 cardiothoracic surgical procedures in children under 18.
- Comparison of outcomes including mortality, ventilation duration, ICU and hospital stay, and antibiotic treatment.
Main Results:
- DP incidence was 1.4% following pediatric cardiothoracic surgery.
- Patients with DP experienced significantly longer mechanical ventilation, ICU stay, hospital stay, and antibiotic treatment.
- Younger age was a predictor for diaphragmatic plication, performed in 54% of DP patients due to respiratory problems.
Conclusions:
- Diaphragmatic palsy significantly prolongs mechanical ventilation, ICU, and hospital stays, particularly in newborns and young infants.
- Spontaneous phrenic nerve recovery is uncommon in pediatric patients with DP.
- Transthoracic diaphragmatic plication is an effective treatment for respiratory impairment caused by DP.
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