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Postoperative unilateral diaphragmatic paralysis in children, a plea for early plication
A Yellin1, Y Lieberman, Z Barzilay
1Department of Thoracic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Unilateral diaphragmatic paralysis (UDP) after heart surgery is common in children. Early diaphragmatic plication surgery can help these patients recover and be weaned from mechanical ventilation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Pulmonology
- Thoracic Surgery
Background:
- Unilateral diaphragmatic paralysis (UDP) is a known complication following cardiovascular operations.
- The incidence of UDP in pediatric patients is at least 1.5%, with a significant portion requiring mechanical ventilation.
- This study reports on six pediatric cases of UDP post-cardiovascular procedures.
Purpose of the Study:
- To evaluate the effectiveness of diaphragmatic plication in pediatric patients with UDP.
- To determine the optimal timing for surgical intervention in cases of UDP with ventilation difficulties.
Main Methods:
- Retrospective review of pediatric patients who developed UDP after cardiovascular surgery.
- Analysis of outcomes following diaphragmatic plication, focusing on timing and success of ventilation weaning.
- Comparison of outcomes between early and late surgical intervention.
Main Results:
- All six pediatric patients in the study required prolonged mechanical ventilation due to UDP.
- Diaphragmatic plication was performed in five patients, with successful weaning achieved in three survivors.
- Late diaphragmatic plication (21-120 days post-ventilation) showed success in 3 out of 5 patients.
Conclusions:
- Diaphragmatic plication is a safe and effective procedure for managing pediatric UDP.
- Early diaphragmatic plication is recommended for children experiencing weaning difficulties secondary to UDP.
- Prompt surgical intervention may improve outcomes and reduce the duration of mechanical ventilation in pediatric UDP cases.
Abstract:
Unilateral diaphragmatic paralysis (UDP) is not an uncommon occurrence after cardiovascular operations. Its incidence in the pediatric age group is at least 1.5%, and severely symptomatic (for example: requiring mechanical ventilation) patients account for about one third of the cases. We have encountered four such cases among 850 children (0.5%) undergoing cardiovascular procedures, and have treated two additional patients. All required prolonged intubation and mechanical ventilation. Diaphragmatic plication in five was performed rather late in the course of their illness, after 21-120 days mechanical ventilation, and was successful in three who survived, allowing weaning from ventilation within 3-6 days. The procedure itself is simple and safe. We recommend that diaphragmatic plication be performed early in children with UDP and weaning difficulties.