-
Journal of Neurology, Neurosurgery, and... Apr 1993
Review
Topics: Emergencies; Humans; Neuromuscular Diseases; Neuromuscular Junction; Peripheral Nerves; Respiration, Artificial; Respiratory Center; Respiratory Paralysis; Spinal Cord; Ventilator Weaning
PubMed: 8482951
DOI: 10.1136/jnnp.56.4.334 -
Seminars in Respiratory and Critical... Jun 2009The diaphragm is a chief muscle of inspiration. Its paralysis can lead to dyspnea and can affect ventilatory function. Diaphragmatic paralysis can be unilateral or... (Review)
Review
The diaphragm is a chief muscle of inspiration. Its paralysis can lead to dyspnea and can affect ventilatory function. Diaphragmatic paralysis can be unilateral or bilateral. The clinical symptoms are more prominent in bilateral diaphragm paralysis. Ventilatory failure and cor pulmonale are usually seen in severe cases. Although an uncommon cause of dyspnea it still remains an underdiagnosed condition. A restrictive process is seen on pulmonary function tests in diaphragm paralysis. The symptoms, oxygenation and vital capacity, usually worsen in supine posture. The diagnoses is usually suspected on chest x-ray and clinical exam and confirmed with sniff test or phrenic nerve stimulation/diaphragm electromyography. In most unilateral cases no treatment is needed, especially in the absence of underlying lung disease. In more severe cases modalities such as diaphragmatic pacing or plication of the diaphragm can be used. In bilateral diaphragm paralysis or in patients with ventilatory failure continuous positive airway pressure or mechanical ventilation and tracheostomy are generally needed. Prognosis is good in unilateral paralysis, especially in the absence of underlying neurological or pulmonary process. Prognosis is usually poor in patients with advanced lung disease, bilateral paralysis, and chronic demyelinating conditions.
Topics: Continuous Positive Airway Pressure; Diaphragm; Dyspnea; Electromyography; Humans; Prognosis; Respiration, Artificial; Respiratory Function Tests; Respiratory Paralysis; Severity of Illness Index; Tracheostomy
PubMed: 19452391
DOI: 10.1055/s-0029-1222445 -
BMJ Case Reports Feb 2022A man in his fifties was injured in a traffic accident and diagnosed with traumatic subarachnoid haemorrhage, liver injury, and fractures of the rib, right clavicle,...
A man in his fifties was injured in a traffic accident and diagnosed with traumatic subarachnoid haemorrhage, liver injury, and fractures of the rib, right clavicle, right scapula and right femur. He also presented with motor and sensory disturbances of the right upper extremity and was suspected of having a brachial plexus injury. After undergoing mechanical ventilation due to multiple traumas, he was extubated. However, he developed acute respiratory failure and required reintubation. Respiratory symptoms were not clear until just before reintubation. The diagnosis of right diaphragm paralysis was made using point-of-care ultrasound with no other findings that could cause respiratory failure. MRI led to the diagnosis of brachial plexus injury, which likely caused diaphragm paralysis. Point-of-care ultrasound provided a clear visualisation and rapid bedside diagnosis of diaphragm paralysis, which can be challenging to diagnose while ruling out other causes of respiratory failure.
Topics: Brachial Plexus; Diaphragm; Humans; Male; Paralysis; Point-of-Care Systems; Respiratory Insufficiency; Respiratory Paralysis
PubMed: 35228232
DOI: 10.1136/bcr-2021-246923 -
Chest Mar 2021A 65-year-old man was admitted to the ICU for septic shock due to pneumonia. He remained on mechanical ventilation for 96 hours. His shock resolved, and he no longer... (Review)
Review
A 65-year-old man was admitted to the ICU for septic shock due to pneumonia. He remained on mechanical ventilation for 96 hours. His shock resolved, and he no longer required IV vasopressor therapy. His vital signs included a BP of 105/70 mm Hg, heart rate 85 beats/min, respiratory rate 22 breaths/min, and oxygen saturation 95%. His ventilator settings were volume control/assist control with a positive end-expiratory pressure of 5 and an Fio set to 40%. On these setting his blood gas showed an Pao of 75 mm Hg. He was following simple commands and had minimal tracheobronchial secretions. He was placed on a spontaneous breathing trial with a spontaneous mode of ventilation and pressure support of 7/5. He remained hemodynamically stable and showed no distress through the procedure, so he was extubated to 6 L oxygen by nasal cannula. Eighteen hours later, the patient was found to have increased work of breathing, with use of accessory respiratory muscles. A blood gas showed an elevated level of CO, so the patient was reintubated. After intubation, the patient again appeared comfortable on minimal ventilator settings. Chest radiography before reintubation showed no new parenchymal process, but an elevated left diaphragm. After a thorough workup, it was determined that diaphragmatic weakness was the most likely reason for respiratory failure. The team questioned whether there was a way to have detected this before extubation.
Topics: Atrophy; Diaphragm; Humans; Point-of-Care Testing; Respiratory Paralysis; Ultrasonography; Ventilator Weaning
PubMed: 33309837
DOI: 10.1016/j.chest.2020.12.003 -
Continuum (Minneapolis, Minn.) Oct 2015Neurologists working in the hospital are often called to evaluate patients with severe muscle weakness. Some of these patients can develop ventilatory compromise and... (Review)
Review
PURPOSE OF REVIEW
Neurologists working in the hospital are often called to evaluate patients with severe muscle weakness. Some of these patients can develop ventilatory compromise and require admission to the intensive care unit (ICU). This article reviews the general evaluation of neuromuscular respiratory failure, discusses its differential diagnosis, and provides practical advice on the management of its most common causes.
RECENT FINDINGS
Determining the cause of acute neuromuscular respiratory failure is crucial because functional prognosis is poor in patients for whom the cause cannot be defined. The differential diagnosis is extensive, but the first step is to discriminate between cases related to a primary neurologic disease (primary neuromuscular respiratory failure) and those provoked by systemic disease, most often critical illness from sepsis and multiorgan failure (secondary neuromuscular respiratory failure). Guillain-Barré syndrome (GBS) and myasthenic crisis are the two most frequent causes of primary neuromuscular respiratory failure. Although they are both autoimmune conditions that benefit from the administration of plasma exchange or IV immunoglobulin (IVIg), they are otherwise very different disorders with unique features and distinct complications. Optimal strategies for mechanical ventilation also differ between these two conditions; while myasthenic crisis is ideally managed with noninvasive bilevel positive airway pressure (BiPAP) ventilation, GBS demands early intubation.
SUMMARY
Prompt recognition of neuromuscular respiratory failure can be lifesaving, and identification of its cause has substantial prognostic implications. Adequate management of these patients requires a multidisciplinary team with the neurologist at its center, not only to guide the diagnostic evaluation but often also to prescribe the optimal management.
Topics: Critical Care; Disease Management; Humans; Respiratory Paralysis
PubMed: 26426233
DOI: 10.1212/CON.0000000000000218 -
Medicine Jan 2021Respiratory dysfunction resulting from unilateral diaphragmatic paralysis during neck trauma is very rare in adults. We describe the symptoms, diagnosis and treatment of...
RATIONALE
Respiratory dysfunction resulting from unilateral diaphragmatic paralysis during neck trauma is very rare in adults. We describe the symptoms, diagnosis and treatment of 1 patient with chronic respiratory insufficiency, in whom the diaphragmatic paralysis was associated with phrenic nerve injury due to penetrating neck trauma.
PATIENT CONCERNS
A 50-year-old worker was admitted because of left penetrating neck trauma. Imaging investigations demonstrated elevation of the left hemidiaphragm and the C5 and C6 roots avulsion. He complained of gradually worsening dyspnea on exertion 2 months later.
DIAGNOSES
The patient was diagnosed with chronic respiratory dysfunction secondary to diaphragmatic paralysis, which caused by phrenic nerve injury.
INTERVENTIONS
A conventional video-assisted thoracoscopic diaphragm plication was performed after failed conservative management.
OUTCOMES
The respiratory status improved markedly, and he did well without recurrence until 2 years' follow-up.
LESSONS
The possibilities of phrenic nerve palsy and diaphragmatic paralysis should not be overlooked during the evaluation of neck trauma.
Topics: Humans; Male; Middle Aged; Neck Injuries; Phrenic Nerve; Respiratory Insufficiency; Respiratory Paralysis; Thoracoscopy; Wounds, Penetrating
PubMed: 33530199
DOI: 10.1097/MD.0000000000024043 -
Pediatric Pulmonology Sep 2019Diaphragmatic paralysis (DP) is a rare cause of respiratory distress in young children. In the first years of life, the main cause is phrenic nerve injury after... (Review)
Review
Diaphragmatic paralysis (DP) is a rare cause of respiratory distress in young children. In the first years of life, the main cause is phrenic nerve injury after cardiothoracic surgery or obstetrical trauma. DP usually presents as respiratory distress. Asymmetrical thorax elevation, difficulty weaning from mechanical ventilation, pulmonary atelectasis, and repeated pulmonary infections are other suggestive signs or complications. DP is usually suspected on chest X-ray showing abnormal hemidiaphragm elevation. Although fluoroscopy was considered the gold standard for DP confirmation, it has gradually been replaced by ultrasound, which can be done at the bedside. Some electrophysiological tools may be useful for a better characterization of phrenic nerve injury and chance of recovery. The management of DP is mainly based on clinical severity. In mild asymptomatic cases, DP may only require close monitoring. In more severe cases, adequate ventilatory support and/or surgical diaphragmatic plication may be needed. Electrophysiological tools may help clinicians assess the ideal timing for diaphragmatic plication.
Topics: Cardiac Surgical Procedures; Diaphragm; Electrodiagnosis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Radiography, Thoracic; Respiration, Artificial; Respiratory Insufficiency; Respiratory Paralysis
PubMed: 31211516
DOI: 10.1002/ppul.24383 -
The American Journal of Medicine Dec 2022
Topics: Humans; Respiratory Paralysis; Muscles
PubMed: 36063863
DOI: 10.1016/j.amjmed.2022.08.018 -
Anesthesiology Apr 2014
Topics: Diaphragm; Humans; Male; Nerve Block; Phrenic Nerve; Respiratory Paralysis; Shoulder
PubMed: 24694858
DOI: 10.1097/ALN.0000000000000131 -
Anesthesiology Apr 2014
Topics: Diaphragm; Humans; Male; Nerve Block; Phrenic Nerve; Respiratory Paralysis; Shoulder
PubMed: 24694859
DOI: 10.1097/ALN.0000000000000132