Diagnosis of diaphragmatic paralysis for mechanical ventilation patients after congenital heart disease surgery by ultrasound: A case crossover study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Dandong ,  ZHUANG Jian , ZHU Weizhong , WU Lan , CHEN Miaoyun , LI Xiaofeng , LI Liuyuan , ZHANG Chongjian

Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, P.R.China;

Corresponding?author：

ZHUANG Jian, Email: zhuangjian5413@tom.com

Keywords：

Congenital heart disease; ultrasound; heart surgery; diaphragmatic paralysis; mechanical ventilation

DOI：

10.7507/1007-4848.201702004

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the feasibility of ultrasound diagnosis of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery. Methods There were 542 patients with congenital heart disease after surgery, difficult to be weaned off the ventilator or suspected diaphragmatic paralysis of the patients, respectively, in the ventilator continous positive pressure breathing (CPAP) mode and completely independent breathing state, whose ultrasound examination of diaphragm function was conducted to determine the presence of diaphragmatic paralysis in our hospital between January 1, 2013 and April 30, 2016. There were 327 males and 215 females at age of 14±32 months. The results of ultrasound diagnosis between ventilator CPAP mode and completely spontaneous breathing mode were compared. Results Five hundred and forty-two patients underwent ultrasound diaphragmatic examination. The results of bedside ultrasound were completely diagnosed: in completely spontaneous breathing, 82 patients who were diagnosed as diaphragmatic paralysis, including 39 on the right, 25 on the left, 18 on both sides; in CPAP mode, 82 patients who were diagnosed as diaphragmatic paralysis, 38 on the right, left 25, bilateral 19. Using ultrasound in CPAP mode to diagnose diaphragmatic paralysis after congenital heart disease surgery, compared with the completely spontaneous breathing state, the sensitivity was 100.0% and the specificity was 99.9%. Conclusion It is accurate and feasible to diagnose the presence of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery.

Citation： LUO Dandong, ZHUANG Jian, ZHU Weizhong, WU Lan, CHEN Miaoyun, LI Xiaofeng, LI Liuyuan, ZHANG Chongjian. Diagnosis of diaphragmatic paralysis for mechanical ventilation patients after congenital heart disease surgery by ultrasound: A case crossover study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(1): 45-48. doi: 10.7507/1007-4848.201702004 Copy

1.	羅丹東, 陳寄梅, 岑堅正, 等. 先天性心臟病術后膈肌麻痹的診斷和處理. 中華小兒外科雜志, 2012, 33(8): 572-574.
2.	Zhang YB, Wang X, Li SJ, et al. Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management. Chin Med J(Engl), 2013, 126(21): 4083-4087.
3.	歐陽輝, 鄔曉臣, 丁盛, 等. 膈肌折疊術治療嬰幼兒先天性心臟病矯治術后膈肌麻痹的臨床療效分析. 中國胸心血管外科臨床雜志, 2014, 21(2): 220-223.
4.	Sanchez DTJ, Munoz R, Landsittel D, et al. Diagnosis of abnormal diaphragm motion after cardiothoracic surgery: ultrasound performed by a cardiac intensivist vs. fluoroscopy. Congenit Heart Dis, 2010, 5(6): 565-572.
5.	Miller SG, Brook MM, Tacy TA. Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: Comparison with fluoroscopy. Pediatr Crit Care Med, 2006, 7(5): 441-444.
6.	李永青, 李守軍, 呂小東, 等. 嬰幼兒心臟手術后膈肌麻痹的超聲診斷. 中國超聲醫學雜志, 2010, 26(7): 631-633.
7.	Akbariasbagh P, Mirzaghayan MR, Akbariasbagh N, et al. Risk factors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease. J Tehran Heart Cent, 2015, 10(3): 134-139.
8.	Healy F, Hanna BD, Zinman R. Pulmonary complications of congenital heart disease. Paediatr Respir Rev, 2012, 13(1): 10-15.
9.	Smith BM, Ezeokoli NJ, Kipps AK, et al. Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery. Ann Thorac Surg, 2013, 96(3): 938-942.
10.	Bhaskar P, Lone RA, Sallehuddin A, et al. Bilateral diaphragmatic palsy after congenital heart surgery: management options. Cardiol Young, 2016, 26(5): 927-930.
11.	Wiesemann S, Haager B, Passlick B. Surgical therapy of acquired unilateral diaphragmatic paralysis: indication and results. Zentralbl Chir, 2016, 141(Suppl 1): S43-S49.
12.	Windisch W, Schonhofer B, Magnet FS, et al. Diagnosis and treatment of diaphragmatic dysfunction. Pneumologie, 2016, 70(7): 454-461.
13.	張燕搏, 王旭, 李守軍, 等. 兒童先天性心臟病術后膈肌麻痹的臨床研究. 中華實用診斷與治療雜志, 2011, 25(12): 1152-1153.
14.	王順民, 徐志偉, 蘇肇伉, 等. 先天性心臟病矯治術后膈肌麻痹的診斷與治療. 中國胸心血管外科臨床雜志, 2009, 16(2): 144-145.
15.	Gil-Juanmiquel L, Gratacos M, Castilla-Fernandez Y, et al. Bedside ultrasound for the diagnosis of abnormal diaphragmatic motion in children after heart surgery. Pediatr Crit Care Med, 2017, 18(2): 159-164.
16.	Lerolle N, Guerot E, Dimassi S, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after ardiac surgery. Chest, 2009, 135(2): 401-407.
17.	Goligher EC, Fan E, Herridge MS, et al. Evolution of diaphragm thickness during mechanical ventilation: impact of inspiratory effort. Am J Respir Crit Care Med, 2015, 192(9): 1080-1088.
18.	Mariani LF, Bedel J, Gros A, et al. Ultrasonography for screening and follow-up of diaphragmatic dysfunction in the ICU: A pilot study. J Intensive Care Med, 2016, 31(5): 338-343.
19.	Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2017, 43(1): 29-38.
20.	Billings ME, Aitken ML, Benditt JO. Bilateral diaphragm paralysis: a challenging diagnosis. Respir Care, 2008, 53(10): 1368-1371.

1. 羅丹東, 陳寄梅, 岑堅正, 等. 先天性心臟病術后膈肌麻痹的診斷和處理. 中華小兒外科雜志, 2012, 33(8): 572-574.
2. Zhang YB, Wang X, Li SJ, et al. Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management. Chin Med J(Engl), 2013, 126(21): 4083-4087.
3. 歐陽輝, 鄔曉臣, 丁盛, 等. 膈肌折疊術治療嬰幼兒先天性心臟病矯治術后膈肌麻痹的臨床療效分析. 中國胸心血管外科臨床雜志, 2014, 21(2): 220-223.
4. Sanchez DTJ, Munoz R, Landsittel D, et al. Diagnosis of abnormal diaphragm motion after cardiothoracic surgery: ultrasound performed by a cardiac intensivist vs. fluoroscopy. Congenit Heart Dis, 2010, 5(6): 565-572.
5. Miller SG, Brook MM, Tacy TA. Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: Comparison with fluoroscopy. Pediatr Crit Care Med, 2006, 7(5): 441-444.
6. 李永青, 李守軍, 呂小東, 等. 嬰幼兒心臟手術后膈肌麻痹的超聲診斷. 中國超聲醫學雜志, 2010, 26(7): 631-633.
7. Akbariasbagh P, Mirzaghayan MR, Akbariasbagh N, et al. Risk factors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease. J Tehran Heart Cent, 2015, 10(3): 134-139.
8. Healy F, Hanna BD, Zinman R. Pulmonary complications of congenital heart disease. Paediatr Respir Rev, 2012, 13(1): 10-15.
9. Smith BM, Ezeokoli NJ, Kipps AK, et al. Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery. Ann Thorac Surg, 2013, 96(3): 938-942.
10. Bhaskar P, Lone RA, Sallehuddin A, et al. Bilateral diaphragmatic palsy after congenital heart surgery: management options. Cardiol Young, 2016, 26(5): 927-930.
11. Wiesemann S, Haager B, Passlick B. Surgical therapy of acquired unilateral diaphragmatic paralysis: indication and results. Zentralbl Chir, 2016, 141(Suppl 1): S43-S49.
12. Windisch W, Schonhofer B, Magnet FS, et al. Diagnosis and treatment of diaphragmatic dysfunction. Pneumologie, 2016, 70(7): 454-461.
13. 張燕搏, 王旭, 李守軍, 等. 兒童先天性心臟病術后膈肌麻痹的臨床研究. 中華實用診斷與治療雜志, 2011, 25(12): 1152-1153.
14. 王順民, 徐志偉, 蘇肇伉, 等. 先天性心臟病矯治術后膈肌麻痹的診斷與治療. 中國胸心血管外科臨床雜志, 2009, 16(2): 144-145.
15. Gil-Juanmiquel L, Gratacos M, Castilla-Fernandez Y, et al. Bedside ultrasound for the diagnosis of abnormal diaphragmatic motion in children after heart surgery. Pediatr Crit Care Med, 2017, 18(2): 159-164.
16. Lerolle N, Guerot E, Dimassi S, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after ardiac surgery. Chest, 2009, 135(2): 401-407.
17. Goligher EC, Fan E, Herridge MS, et al. Evolution of diaphragm thickness during mechanical ventilation: impact of inspiratory effort. Am J Respir Crit Care Med, 2015, 192(9): 1080-1088.
18. Mariani LF, Bedel J, Gros A, et al. Ultrasonography for screening and follow-up of diaphragmatic dysfunction in the ICU: A pilot study. J Intensive Care Med, 2016, 31(5): 338-343.
19. Zambon M, Greco M, Bocchino S, et al. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med, 2017, 43(1): 29-38.
20. Billings ME, Aitken ML, Benditt JO. Bilateral diaphragm paralysis: a challenging diagnosis. Respir Care, 2008, 53(10): 1368-1371.

Previous Article
Correlation study of expressions of silence signal regulating factor-1 and E-cadherin in gastric cancer
Next Article
Surgical diagnosis and treatment of carotid body tumor: a report of 27 cases

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis of diaphragmatic paralysis for mechanical ventilation patients after congenital heart disease surgery by ultrasound: A case crossover study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content