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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
2
|
| pubmed:dateCreated |
1994-3-8
|
| pubmed:abstractText |
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 and prolonged difficulties in weaning from mechanical ventilation. The mean time of measurement from the operation day was 31 +/- 19 days (range 8 to 78). With the same technique we also evaluated 12 control patients: four patients at day 1 after cardiac operation while they were still intubated; four normally convalescing patients at day 7 or 8 after cardiac operation; and four patients who required prolonged mechanical ventilation because of another identified cause after cardiac operation. Diaphragmatic function was evaluated at the bedside from esophageal and gastric pressure measurements. A low or negative ratio of gastric pressure swing to transdiaphragmatic pressure swing, indicative of diaphragm dysfunction, was found in all 13 patients (mean -0.39 +/- 0.64). The difference between the 13 patients and all control groups was found to be highly significant. Transdiaphragmatic pressure measured during a maximal voluntary inspiratory effort and transdiaphragmatic pressure measured during a short, sharp sniff were markedly diminished (28 +/- 18 cm H2O and 13 +/- 15 cm H2O, respectively) in the 13 patients, significantly different from values in the four control patients studied at day 7 or 8. Transdiaphragmatic pressure measured after magnetic stimulation in four patients was also markedly reduced (7 +/- 5 cm H2O) as compared with normal theoretic values. Aminophylline infusion had no effect on any of these parameters. In one of two patients evaluated a second time, about 5 weeks later, a marked improvement was observed. Estimating the prevalence of clinically relevant diaphragmatic dysfunction, we found it to be 0.5% when no topical cooling was used and 2.1% when iced slush with no insulation pad was added for myocardial protection (p < 0.005). The most striking finding was that the clinical course of the 13 patients was marked by severe intercurrent events, including cardiorespiratory arrest after early tracheal extubation in 5 patients, nosocomial pneumonia in 11, prolonged mechanical ventilation in all (58 +/- 41 days), and a fatal outcome in 3. We conclude that prolonged postoperative diaphragmatic dysfunction may cause severe life-threatening complications after cardiac operation and can be limited to some extent by avoiding the use of iced slush topical cooling of the heart.
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| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
AIM
|
| pubmed:chemical | |
| pubmed:status |
MEDLINE
|
| pubmed:month |
Feb
|
| pubmed:issn |
0022-5223
|
| pubmed:author | |
| pubmed:issnType |
Print
|
| pubmed:volume |
107
|
| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
|
| pubmed:pagination |
487-98
|
| pubmed:dateRevised |
2008-11-21
|
| pubmed:meshHeading |
pubmed-meshheading:8302068-Adult,
pubmed-meshheading:8302068-Aged,
pubmed-meshheading:8302068-Cardiac Surgical Procedures,
pubmed-meshheading:8302068-Case-Control Studies,
pubmed-meshheading:8302068-Female,
pubmed-meshheading:8302068-Humans,
pubmed-meshheading:8302068-Ice,
pubmed-meshheading:8302068-Male,
pubmed-meshheading:8302068-Middle Aged,
pubmed-meshheading:8302068-Phrenic Nerve,
pubmed-meshheading:8302068-Postoperative Complications,
pubmed-meshheading:8302068-Respiration,
pubmed-meshheading:8302068-Respiration, Artificial,
pubmed-meshheading:8302068-Respiratory Paralysis
|
| pubmed:year |
1994
|
| pubmed:articleTitle |
Clinically relevant diaphragmatic dysfunction after cardiac operations.
|
| pubmed:affiliation |
Service de Chirurgie Cardiaque, INSERM U296, Université Paris XII, Hôpital Henri Mondor, Creteil, France.
|
| pubmed:publicationType |
Journal Article
|