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Diaphragmatic dysfunction after open heart surgery: treatment with a rocking bed
A G Abd1, N M Braun, M I Baskin
1St. Luke's-Roosevelt Hospital Center, New York, New York.
Annals of Internal Medicine
|December 1, 1989
Summary
Phrenic nerve injury after open-heart surgery can cause diaphragmatic dysfunction, particularly with internal mammary artery grafting. Recovery, aided by rocking bed ventilation, occurred in 4-27 months, restoring function and relieving symptoms.
Area of Science:
- Cardiology
- Thoracic Surgery
- Neurology
Background:
- Phrenic nerve injury is a known complication of open-heart surgery.
- Diaphragmatic dysfunction can result from phrenic nerve injury, impacting respiratory function.
- Internal mammary artery grafting is frequently associated with these complications.
Purpose of the Study:
- To investigate the incidence and characteristics of diaphragmatic dysfunction post-open-heart surgery.
- To identify potential contributing factors, including internal mammary artery grafting.
- To evaluate the recovery process and effectiveness of interventions for phrenic nerve injury.
Main Methods:
- Retrospective analysis of 1225 patients undergoing open-heart surgery.
- Clinical assessment, fluoroscopy with phrenic nerve stimulation, vital capacity, respiratory muscle strength, and phrenic nerve latency measurements.
- Implementation of rocking bed ventilation for patients with diaphragmatic dysfunction.
Main Results:
- 13 patients (1.06%) developed diaphragmatic dysfunction due to phrenic nerve injury.
- 11 of these patients had internal mammary artery grafts; 9 had dysfunction on the graft side.
- Recovery ranged from 4 to 27 months, with unilateral recovery sufficient for symptom relief.
Conclusions:
- Phrenic nerve injury leading to diaphragmatic dysfunction is a significant complication after open-heart surgery, especially with IMA grafting.
- Rocking bed ventilation facilitates recovery, which can be lengthy but ultimately restores function.
- Early identification and management are crucial for patient outcomes.
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