Clinically relevant diaphragmatic dysfunction after cardiac operations

摘要: Phrenic nerve injury and diaphragmatic dysfunction can be induced by cardiac operation. The clinical consequences are not well-established. We evaluated 13 consecutive patients over a 2-year period with unexplained prolonged difficulties in weaning from mechanical ventilation. mean time of measurement the operation day was 31 ± 19 days (range 8 to 78). With same technique we also 12 control patients: four at 1 after while they were still intubated; normally convalescing 7 or operation; who required ventilation because another identified cause Diaphragmatic function bedside esophageal gastric pressure measurements. A low negative ratio swing transdiaphragmatic swing, indicative diaphragm dysfunction, found all (mean -0.39 0.64). difference between groups highly significant. Transdiaphragmatic measured during maximal voluntary inspiratory effort short, sharp sniff markedly diminished (28 18 cm H2O 15 H2O, respectively) patients, significantly different values studied 8. magnetic stimulation reduced (7 5 H2O) as compared normal theoretic values. Aminophylline infusion had no effect on any these parameters. In one two second time, about weeks later, marked improvement observed. Estimating prevalence clinically relevant it 0.5 % when topical cooling used 2.1 iced slush insulation pad added for myocardial protection (p