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Bilateral diaphragm paralysis following cardiac surgery in children: 10-years' experience
Ovadia Dagan1, Revital Nimri, Yakov Katz
1Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. cicu_Schneider@clalit.org.il
Insights
Conservative management of bilateral diaphragm paralysis after pediatric cardiac surgery is effective, with most patients recovering within 7 weeks and experiencing minor complications. This approach offers a good prognosis for children.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Bilateral diaphragm paralysis is a rare complication following pediatric cardiac surgery.
- Understanding its incidence and management is crucial for patient outcomes.
Purpose of the Study:
- To review the incidence and complications of conservative management for bilateral diaphragm paralysis in children post-cardiac surgery.
- To assess the prognosis and recovery time associated with this condition.
Main Methods:
- Retrospective clinical review of a computerized database.
- Analysis of data from 3,214 pediatric patients undergoing cardiac operations between 1995 and 2004.
- Inclusion of nine patients diagnosed with bilateral diaphragm paralysis.
Main Results:
- The incidence of bilateral diaphragm paralysis was 0.28% (9 out of 3,214 patients).
- Mechanical ventilation was required for 14-62 days, with a maximum recovery time of 7 weeks.
- All patients survived, with one experiencing minor subglottic stenosis; three underwent unilateral plication.
Conclusions:
- Conservative management of bilateral diaphragm paralysis in pediatric cardiac surgery patients yields good prognosis and minimal complications.
- Recovery is typically achieved within 7 weeks, supporting a non-operative approach for most cases.
Objective:
To review the incidence and complications of conservative management of bilateral diaphragm paralysis following pediatric cardiac surgery.
Design And Setting:
Retrospective clinical review based on computerized database with daily follow-up in a pediatric cardiac intensive care unit in a tertiary care center. PATIENT AND PARTICIPANTS: Were reviewed the data on nine patients with bilateral diaphragm paralysis from the 3,214 consecutive children (0.28%) after operations performed between 1995 and 2004.
Measurements And Results:
A fluoroscopy-confirmed diagnosis of bilateral diaphragm paralysis was made in all nine patients. Mechanical ventilation was required for 14-62 days; maximum time to recovery was 7 weeks. Three patients underwent unilateral plication. Patients with a complicated postoperative course required longer mechanical ventilation. All patients were managed with a nasotracheal tube. One patient had minor subglottic stenosis. All patients survived.
Conclusions:
Bilateral diaphragm paralysis can be managed conservatively with good prognosis and minor complications. The recovery time is relatively short, less than 7 weeks.
