32 results match your criteria Diaphragm Injury and Paresis

Metabolomic Profiling of Respiratory Muscles and Lung in Response to Long-Term Controlled Mechanical Ventilation.

Front Cell Dev Biol 2022 22;10:849973. Epub 2022 Mar 22.

Department of Physiology and Pharmacology, Karolinska Institutet, Bioclinicum, Stockholm, Sweden.

Critical illness myopathy (CIM) and ventilator-induced diaphragm dysfunction (VIDD) are characterized by severe muscle wasting, muscle paresis, and extubation failure with subsequent increased medical costs and mortality/morbidity rates in intensive care unit (ICU) patients. These negative effects in response to modern critical care have received increasing attention, especially during the current COVID-19 pandemic. Based on experimental and clinical studies from our group, it has been hypothesized that the ventilator-induced lung injury (VILI) and the release of factors systemically play a significant role in the pathogenesis of CIM and VIDD. Read More

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Editorial Commentary: The Evolution of Regional Anesthesia in Arthroscopic Rotator Cuff Repair: From Throbbing Shoulders to Paralyzed Diaphragms.

Arthroscopy 2021 11;37(11):3238-3240

Wake Forest Baptist Health.

Rotator cuff repair may result in significant postoperative pain. Although opioids were once the gold standard, addiction and other side effects are of significant concern. Nonsteroidal anti-inflammatory drugs reduce pain, sleep disturbance, and need for opioids, but they may impair soft tissue healing. Read More

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November 2021

A Case Report of Bilateral Phrenic Nerve Dysfunction After Unilateral Supraclavicular Brachial Plexus Block: Unveiling Preexisting Diaphragmatic Dysfunction.

A A Pract 2021 Mar 30;15(4):e01430. Epub 2021 Mar 30.

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.

A 48-year-old woman with a history of cardiac surgery developed severe dyspnea and anxiety following right-sided supraclavicular nerve block for hand surgery. In this case, right phrenic nerve blockade from a supraclavicular block unmasked a subclinical hemidiaphragmatic paresis from phrenic nerve injury on the left, the latter likely due to previous cardiac surgery. When performing brachial plexus block at or above the clavicle, particularly for prior cardiothoracic surgical patients, anesthesiologists can easily, quickly, and inexpensively use point-of-care ultrasound to assess whether any degree of phrenic nerve dysfunction exists on the contralateral side, as patients may be asymptomatic at baseline. Read More

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Diaphragmatic paralysis after phrenic nerve injury in newborns.

J Pediatr Surg 2020 Feb 5;55(2):240-244. Epub 2019 Nov 5.

Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address:

Background: Phrenic nerve injury (PNI) from birth trauma is a recognized phenomenon, generally occurring with ipsilateral brachial plexus palsy (BPP). In severe cases, PNI results in diaphragm paresis (DP) and respiratory insufficiency. Surgical diaphragmatic plication (SDP) is a potential management strategy for patients with PNI and DP, but timing and outcomes associated with SDP have not been rigorously studied. Read More

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February 2020

Postoperative acute respiratory failure in cardiac surgery.

Khirurgiia (Mosk) 2019 (8):5-11

Intensive Care Unit of the Petrovsky Russian Research Center for Surgery, Moscow, Russia.

Objective: To evaluate incidence, causes and outcomes of acute respiratory failure (ARF) in patients after cardiac and aortic surgery.

Material And Methods: A retrospective trial included 3972 patients after elective cardiovascular procedures for the period 2013-2017. Inclusion criterion: sustained reduction of pulmonary function (PaO/FiO<300 mm Hg) in the postoperative period required mechanical ventilation or non-invasive positive pressure mask ventilation for at least 24 h. Read More

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October 2019

Bilateral diaphragmatic paresis following pediatric liver transplantation.

SAGE Open Med Case Rep 2017 16;5:2050313X17719214. Epub 2017 Jul 16.

Division of Pediatric Pulmonology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.

Background: Although diaphragm paresis or paralysis is fairly common following cardiac procedures; it is a less common complication following liver transplantation. Unilateral diaphragm paresis, usually right sided, has been described following liver transplantation in adults and has been rarely described in children.

Purpose: Diaphragmatic injury following LT is often unrecognized and is typically unilateral, involving the right hemidiaphragm. Read More

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The advantage of early plication in children diagnosed with diaphragm paresis.

J Thorac Cardiovasc Surg 2017 11 15;154(5):1715-1721.e4. Epub 2017 Jun 15.

Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.

Background: In this single-center study, we sought to determine the frequency of phrenic nerve injury leading to diaphragm paresis (DP) in children following open cardiac surgery over the last 10 years, and to identify possible variables that predict the need for plication and associated clinical outcomes.

Methods: Patients diagnosed with DP were identified from departmental databases and a review of clinical diaphragm ultrasound images. A cohort was analyzed for predictors of diaphragm plication and associations with clinical outcomes. Read More

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November 2017

Brachial plexus block in a parturient.

Int J Obstet Anesth 2014 May 8;23(2):185-8. Epub 2014 Jan 8.

Department of Anesthesia, Walter Reed National Military Medical Center, Bethesda, MD, USA.

We report a novel circumstance of brachial plexus anesthesia in a parturient. A 25-year-old woman at 34 weeks of gestation presented with a pathologic proximal right humerus fracture from an intramedullary mass. She was scheduled for tumor biopsy which was performed using a two-site ultrasound-guided brachial plexus block to maximize odds of complete anesthesia while minimizing the risk of phrenic nerve paresis. Read More

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Respiratory management in the patient with spinal cord injury.

Biomed Res Int 2013 9;2013:168757. Epub 2013 Sep 9.

Critical Care Unit, Complexo Hospitalario Universitario A Coruña, CP. 15006, A Coruña, Spain.

Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Read More

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Phrenic nerve injury after paediatric heart surgery: is aggressive plication of the diaphragm beneficial?

Eur J Cardiothorac Surg 2013 Nov 1;44(5):808-12. Epub 2013 Mar 1.

Department of Pediatric Cardiology, National Heart Hospital, Sofia, Bulgaria.

Objectives: Phrenic nerve injury after paediatric heart surgery is associated with significant morbidity. Surgical plication of the diaphragm is believed to be beneficial to the patient, with difficult weaning from ventilation; however, the optimal timing remains unclear. We aimed to compare the outcome after two different strategies for treating hemidiaphragmatic paresis. Read More

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November 2013

Right phrenic injury after radiofrequency catheter ablation of atrial tachycardia at crista terminalis.

Chin Med J (Engl) 2011 May;124(10):1588-9

Cardiac Arrhythmia Center, Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China.

A 62-year-old woman with frequent occurrence of symptomatic atrial tachycardia with a foci located at the root of the upper crista terminalis was found to have right diaphragm paresis after receiving a total of 8 radiofrequency energy deliveries (40-60 W, 50-60ºC) and a total duration of 540 seconds of ablation therapy (7Fr 8 mm deflectable ablation catheter). The right diaphragm paresis remained resolved up to 14 months after the procedure as confirmed by repeated chest X-rays. Read More

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Hemidiaphragm plication after repair of congenital heart defects in children: quantitative return of diaphragm function over time.

J Thorac Cardiovasc Surg 2008 Jan 26;135(1):56-61. Epub 2007 Dec 26.

Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, Calif 90033, USA.

Objective: Phrenic nerve injury resulting in hemidiaphragm paresis leads to morbidity in children undergoing repair of congenital heart defects. Previous studies have documented short-term benefits of diaphragm plication, but little is known about the return of diaphragm function.

Methods: We reviewed 46 consecutive patients undergoing hemidiaphragm plication after repair of congenital heart defects. Read More

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January 2008

Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions.

K T Ragnarsson

Spinal Cord 2008 Apr 11;46(4):255-74. Epub 2007 Sep 11.

Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.

Repair of the injured spinal cord by regeneration therapy remains an elusive goal. In contrast, progress in medical care and rehabilitation has resulted in improved health and function of persons with spinal cord injury (SCI). In the absence of a cure, raising the level of achievable function in mobility and self-care will first and foremost depend on creative use of the rapidly advancing technology that has been so widely applied in our society. Read More

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Right phrenic nerve injury following electrical disconnection of the right superior pulmonary vein.

Pacing Clin Electrophysiol 2004 Oct;27(10):1444-6

Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.

This report describes a case of transient paresis of the right diaphragm following the transcatheter radiofrequency ablation for the electrical disconnection of pulmonary veins, which recovered completely during the observational period in a 61-year-old woman with paroxysmal atrial fibrillation. For electrical disconnection of pulmonary veins, careful preventive measures for phrenic nerve damage are required. Read More

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October 2004

Thoracovisceral segment aneurysm repair after previous infrarenal abdominal aortic aneurysm surgery.

J Vasc Surg 2004 Jun;39(6):1163-70

Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Objective: Repair of thoracovisceral aortic aneurysms (TVAA) after previous open repair of an infrarenal abdominal aortic aneurysm (AAA) poses significant challenges. We sought to better characterize such recurrent aneurysms and to evaluate their operative outcome.

Methods: We reviewed the records and radiographs of 49 patients who underwent repair of TVAAs between 1988 and 2002 after previous repair of an AAA. Read More

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Surgical repair of thoracoabdominal aneurysms: patient selection, techniques and results.

Peter Gloviczki

Cardiovasc Surg 2002 Aug;10(4):434-41

Division of Vascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.

Background: Repair of thoracoabdominal aortic aneurysms (TAAAs) continues to be a challenging task. Hemorrhagic shock, cardiac arrest and multisystem organ failures are the most frequent causes of death, and paraplegia and renal failure are the most devastating complications.

Methods: Flawless surgical technique and the use of adjuncts to protect key organs including the brain, heart, spinal cord, liver and kidneys affect outcome. Read More

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Phrenic paresis--a possible additional spinal cord dysfunction induced by neck manipulation in cervical spondylotic myelopathy (CSM): a report of two cases with anatomical and clinical considerations.

Clin Anat 2001 May;14(3):173-8

The Robert E. Van Demark Institute of Anatomical Research, Division of Basic Medical Sciences, University of South Dakota School of Medicine, Vermillion, South Dakota, USA.

The clinical records of two male subjects with severe cervical spondylotic myelopathy (CSM) who developed respiratory insufficiency after the cervical manipulation involved in preoperative anesthetic intubation were examined. Their cervical imaging was analyzed with respect to the known anatomic relationships of the spinal phrenic nerve nuclei to the spondylotic compressive lesions in an attempt to provide the anatomic and pathologic rationales that may explain this phrenic paresis as a possible traumatic complication of severe CSM. Perusal of extant literature revealed extensive descriptions of CSM symptoms, but none had previously reported an associated neuromuscular weakness of the diaphragm. Read More

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[Diagnostic-therapeutic Algorithm in a Blunt Injury of the Thorax.].

Acta Chir Orthop Traumatol Cech 2000 ;67(5):324-8

Traumatologické centrum FNKV, Praha.

Based on the group of 22 patients operated on for a blunt injury of the thorax a diagnostic-therapeutic algorithm was evaluated in the procedure of the treatment of a severe trauma of the thorax. Acute thoracotomy or laparotomy was performed in 17 patients and in 5 of them thoracotomy was indicated only after some time interval. In the patients with acute surgery the indication was a rupture of diaphragm, massive hemotorax in case of lung laceration of bleeding from thoracic wall, rupture of bronchus and an associated injury of intra-abdominal parenchymal organs. Read More

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October 2012

Minimally invasive diaphragm plication in an infant.

Ann Thorac Surg 1998 Mar;65(3):842-4

Division of Cardiovascular Surgery, Miami Children's Hospital, Florida 33155-4069, USA.

We report the use of video-assisted thoracic surgery to plicate the diaphragm after phrenic nerve injury associated with an operation for congenital heart disease. Right diaphragm paresis developed in a cyanotic newborn girl with pulmonary atresia and intact ventricular septum after a right modified Blalock-Taussig shunt. Diaphragm plication was performed endoscopically and the patient recovered. Read More

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Traumatic diaphragmatic injuries: spectrum of radiographic findings.

Radiographics 1998 Jan-Feb;18(1):49-59

Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA.

Traumatic diaphragmatic injuries are usually caused by blunt trauma or penetrating injuries. The diagnosis may be delayed due to confusing clinical and radiographic findings. According to the results of a review of 25 cases, the diagnosis of diaphragmatic injury is more often delayed and requires more imaging studies in cases of blunt trauma than in cases of penetrating injury. Read More

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[Use of ultravist to examine the gastrointestinal tract in patients with emergency abdominal pathology].

Vestn Rentgenol Radiol 1997 May-Jun(3):51-2

Scientific Research Institute of Emergency Care of NV Sklifosovskiĭ.

The paper deals with the results of using the nonionic water soluble contrast agents ultravist 300 and ultravist 370 (Schoring, Germany) to examine the gastrointestinal tract (GIT) in 21 patients with acute abdominal abnormality. GIT contrasting was made in 9 patients in the early postoperative period and in 12 patients on their admission to the Institute. The examinations revealed the high contrast rate of the above agent when administered into the stomach and upper small intestine, which excluded failure of gastroenteroanastomic sutures and the sutured gastric wall in 2 patients, established, in terms of gastric displacement and deformity, left-sided subdiaphragmatic abscess, and in terms of transposition of a portion of the gastric fornix into the pleural cavity, rupture of the left diaphragm, and to exclude diaphragmatic rupture with closed abdominal injury. Read More

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[Diaphragmatic paresis as a late radiation injury].

Duodecim 1996 ;112(14):1304-6

Hyvinkaa Regional Hospital, Hyvinkaa, Finland.

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February 2001

Diaphragmatic paresis in newborns due to phrenic nerve injury.

Neuropediatrics 1995 Oct;26(5):281-4

Neurological Department, Kaiser Franz Josef Spital, Vienna, Austria.

Phrenic nerve lesions as a result of birth trauma have been reported as a cause of acute respiratory distress infrequently. We report recent diagnostic and therapeutic experiences in four newborns with birth-traumatic phrenic nerve injury: one bilaterally, and three unilaterally, all right-sided. In each case, mechanical ventilation was required for at least 16 days. Read More

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October 1995

Möbius sequence: further in vivo support for the subclavian artery supply disruption sequence.

Am J Med Genet 1993 Aug;47(2):289-93

Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut.

Möbius sequence consists of a congenital bilateral facial nerve palsy and external ophthalmoplegia often associated with malformations of the limbs and orofacial structures. The pathogenesis of the sequence is a subject of debate. However, a new hypothesis proposes that Möbius sequence results from an interruption of embryonic blood supply (subclavian artery supply disruption sequence). Read More

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Recovery after unilateral phrenic injury associated with coronary artery revascularization.

Chest 1990 Sep;98(3):661-6

Department of Medicine, University of British Columbia, Vancouver, Canada.

Hemidiaphragmatic paralysis occurs in some patients following CAB surgery, possibly related to an intraoperative stretch or cold-induced phrenic injury. To determine the time and extent of recovery of phrenic nerve function, we studied five patients with left phrenic paresis or paralysis after CAB. The FVC, FEV1, Pmax and PEmax pressures, latency of conduction and amplitude of CDAP with phrenic nerve stimulation, and diaphragmatic excursion during fluoroscopy were measured for 12 months after CAB. Read More

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September 1990

Brachial plexus injury and hypoglossal paralysis.

Pediatr Neurol 1989 May-Jun;5(3):197-8

Division of Neonatology, Hôpital Cantonal Universitaire, Geneva, Switzerland.

Two neonates born after traumatic deliveries presented with injuries of the upper brachial plexus and ipsilateral hypoglossal nerve. In addition, 1 patient presented with paresis of the diaphragm after breech delivery; the other patient presented with signs of recurrent laryngeal nerve involvement after vertex delivery. Both infants recovered spontaneously. Read More

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Phrenic nerve function and its relationship to atelectasis after coronary artery bypass surgery.

Chest 1988 Apr;93(4):693-8

University of British Columbia Pulmonary Research Laboratory, St. Paul's Hospital, Vancouver, Canada.

Atelectasis following coronary artery bypass surgery (CAB) occurs in the majority of patients. To determine the importance of operative variables in the development of postoperative atelectasis and the incidence of phrenic nerve injury caused by topical cold cardioplegic solution, we studied 57 patients (53 male, four female) undergoing CAB. Their mean age, +/- SD, was 58 +/- 13 years. Read More

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Etiology and prevention of topical cardiac hypothermia-induced phrenic nerve injury and left lower lobe atelectasis during cardiac surgery.

Chest 1985 Nov;88(5):680-3

Left hemidiaphragm elevation is frequently noted following cardiac surgery employing topical hypothermia. We speculate that contact of the left phrenic nerve with ice causes nerve injury, resulting in left hemidiaphragm paresis or paralysis and left lower lobe atelectasis. Left diaphragm elevation was noted on postoperative chest x-ray examination of 36 of 60 (60 percent) consecutive patients in whom topical cooling of the heart with a cold slush solution was administered prior to use of a cardiac insulation pad (CIP, Shiley Laboratories, Irvine, California). Read More

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November 1985

A physiological approach to hemidiaphragm paralysis.

J L Robotham

Crit Care Med 1979 Dec;7(12):563-6

The occurrence of unilateral phrenic nerve injury with the resultant hemidiaphragm paralysis or paresis can cause significant respiratory distress or respiratory failure in infants and children. An early bedside diagnosis of this problem will allow appropriate therapy and prevent needless diagnostic procedures. With the patient in the lateral decubitus position and the paralyzed side up, accentuated paradoxical inspiratory inward epigastric motion ipsilateral to the paralyzed hemidiaphragm can be seen. Read More

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December 1979