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Clinically relevant diaphragmatic dysfunction after cardiac operations

J L Diehl1, F Lofaso, P Deleuze

  • 1Service de Chirurgie Cardiaque, INSERM U296, Université Paris XII, Hôpital Henri Mondor, Creteil, France.

The Journal of Thoracic and Cardiovascular Surgery
|February 1, 1994
PubMed
Summary
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Cardiac surgery can cause phrenic nerve injury and diaphragmatic dysfunction, leading to prolonged mechanical ventilation. This dysfunction significantly increases the risk of severe, life-threatening complications post-operation.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Pulmonology
  • Critical Care Medicine

Background:

  • Phrenic nerve injury and diaphragmatic dysfunction are potential complications following cardiac operations.
  • The clinical significance and established consequences of post-cardiac surgery diaphragmatic dysfunction remain unclear.
  • Prolonged mechanical ventilation weaning difficulties may indicate underlying diaphragmatic dysfunction.

Purpose of the Study:

  • To evaluate diaphragmatic function in patients experiencing unexplained difficulties weaning from mechanical ventilation after cardiac surgery.
  • To compare diaphragmatic function between patients with prolonged ventilation and control groups.
  • To determine the prevalence and clinical impact of diaphragmatic dysfunction post-cardiac operation.

Related Experiment Videos

Main Methods:

  • Bedside evaluation of diaphragmatic function using esophageal and gastric pressure measurements in 13 patients and 12 controls.
  • Assessment included transdiaphragmatic pressure during maximal voluntary inspiratory effort and sniff maneuvers.
  • Magnetic stimulation of the phrenic nerve was used in a subset of patients.

Main Results:

  • All 13 patients exhibited diaphragmatic dysfunction, indicated by a low/negative gastric to transdiaphragmatic pressure swing ratio.
  • Markedly diminished transdiaphragmatic pressures were observed in patients compared to controls.
  • Diaphragmatic dysfunction prevalence was 0.5% without topical cooling and 2.1% with iced slush topical cooling (p < 0.005).

Conclusions:

  • Prolonged diaphragmatic dysfunction after cardiac surgery can lead to severe, life-threatening complications, including cardiorespiratory arrest and death.
  • The use of iced slush topical cooling during myocardial protection is associated with a higher incidence of diaphragmatic dysfunction.
  • Avoiding iced slush topical cooling may help mitigate the risk of postoperative diaphragmatic dysfunction.