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Functional restoration of diaphragmatic paralysis: an evaluation of phrenic nerve reconstruction
Journal article   Peer reviewed

Functional restoration of diaphragmatic paralysis: an evaluation of phrenic nerve reconstruction

Matthew R Kaufman, Andrew I Elkwood, Alan R Colicchio, John CeCe, Reza Jarrahy, Lourens J Willekes, Michael I Rose and David Brown
The Annals of thoracic surgery, v 97(1), pp 260-266
Jan 2014
DOI: https://doi.org/10.1016/j.athoracsur.2013.09.052
PMID: 24266954
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.athoracsur.2013.09.052View
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Abstract

Adult Aged Aged, 80 and over Diaphragm - innervation Diaphragm - physiopathology Diaphragm - surgery Electromyography - methods Female Follow-Up Studies Humans Male Middle Aged Neurosurgical Procedures - methods Phrenic Nerve - pathology Phrenic Nerve - surgery Reconstructive Surgical Procedures - methods Respiratory Paralysis - diagnosis Respiratory Paralysis - surgery Retrospective Studies Risk Assessment Severity of Illness Index Spirometry - methods Time Factors Treatment Outcome
Unilateral diaphragmatic paralysis causes respiratory deficits and can occur after iatrogenic or traumatic phrenic nerve injury in the neck or chest. Patients are evaluated using spirometry and imaging studies; however, phrenic nerve conduction studies and electromyography are not widely available or considered; thus, the degree of dysfunction is often unknown. Treatment has been limited to diaphragmatic plication. Phrenic nerve operations to restore diaphragmatic function may broaden therapeutic options. An interventional study of 92 patients with symptomatic diaphragmatic paralysis assigned 68 (based on their clinical condition) to phrenic nerve surgical intervention (PS), 24 to nonsurgical (NS) care, and evaluated a third group of 68 patients (derived from literature review) treated with diaphragmatic plication (DP). Variables for assessment included spirometry, the Short-Form 36-Item survey, electrodiagnostics, and complications. In the PS group, there was an average 13% improvement in forced expiratory volume in 1 second (p < 0.0001) and 14% improvement in forced vital capacity (p < 0.0001), and there was corresponding 17% (p < 0.0001) and 16% (p < 0.0001) improvement in the DP cohort. In the PS and DP groups, the average postoperative values were 71% for forced expiratory volume in 1 second and 73% for forced vital capacity. The PS group demonstrated an average 28% (p < 0.01) improvement in Short-Form 36-Item survey reporting. Electrodiagnostic testing in the PS group revealed a mean 69% (p < 0.05) improvement in conduction latency and a 37% (p < 0.0001) increase in motor amplitude. In the NS group, there was no significant change in Short-Form 36-Item survey or spirometry values. Phrenic nerve operations for functional restoration of the paralyzed diaphragm should be part of the standard treatment algorithm in the management of symptomatic patients with this condition. Assessment of neuromuscular dysfunction can aid in determining the most effective therapy.

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Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Respiratory System
Surgery
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