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Diaphragmatic paralysis in children: a review of 11 cases
M C Commare1, S P Kurstjens, A Barois
1Pediatric Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.
Insights
Pediatric diaphragmatic paralysis, often diagnosed clinically, typically resolves with mechanical ventilation. Most children recover respiratory function, though some may develop chronic lung disease.
Area of Science:
- Pediatric Intensive Care Medicine
- Pediatric Pulmonology
- Pediatric Neurology
Background:
- Diaphragmatic paralysis in children can result from birth trauma, congenital heart disease surgery, or trauma.
- Nonspinal cord injury is a key etiology in pediatric diaphragmatic paralysis.
Observation:
- Clinical signs include respiratory distress, ventilator dependence, and paradoxical abdominal movement.
- Diagnostic tools include chest radiography, fluoroscopy, ultrasound, and electromyography.
- Bilateral diaphragmatic paralysis was observed in 8 out of 11 pediatric cases.
Findings:
- Mechanical ventilation was required for all patients, with 5 needing tracheostomy.
- Most children (7/11) recovered without sequelae, achieving respiratory autonomy within months.
- Two patients developed chronic lung disease, and one mortality occurred due to extubation accident.
Implications:
- Clinical suspicion is crucial for diagnosing pediatric diaphragmatic paralysis.
- Effective management with mechanical ventilation generally leads to favorable outcomes.
- Further research into preventing and managing chronic lung disease in these patients is warranted.
Abstract:
We reviewed 11 pediatric cases of diaphragmatic paralysis related to nonspinal-cord injury which were managed in our Intensive Care Unit over the past 10 years. Three cases were secondary to birth trauma, 7 followed surgical procedures for congenital heart disease, and 1 occurred in association with injuries sustained in a motor vehicle accident. The paralysis was bilateral in 8 children. The diagnosis was initially suspected on clinical grounds because of respiratory distress, impossibility of weaning from the ventilator, and paradoxical abdominal respiratory movements. Confirmatory investigations included chest radiography, which revealed elevation of the affected hemidiaphragm, fluoroscopy and ultrasound, both of which demonstrated diminished diaphragmatic movement. Electromyography exhibited a failure of diaphragmatic response to phrenic nerve stimulation in 8 patients. All patients were mechanically ventilated; tracheostomy was required in 5 patients. Physiotherapy was considered a beneficial adjuvant measure. Diaphragmatic plication was attempted without success in 3 children. Seven children recovered without sequelae: Partial respiratory autonomy was achieved after an average of 2.6 months, complete autonomy after an average of 5.4 months. Two patients developed chronic lung disease; one of them remains unresponsive, and one child died following accidental extubation. We conclude that the diagnosis of diaphragmatic paralysis is predominantly clinical, and that the outcome of patients treated by adequate endotracheal mechanical ventilation is usually favorable.