ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 3 (2022), DIAGNOSTIC AND INTENSIVE CARE IN ACUTE RESPIRATORY FAILURE
No. 3 (2022)
DIAGNOSTIC AND INTENSIVE CARE IN ACUTE RESPIRATORY FAILURE

Treatment option for diaphragm dysfunction after cardiac surgery: a review and a clinical case

Published 29.07.2022
K.V. Paromov
Volosevich First City Clinical Hospital, Arkhangelsk, Russia
https://orcid.org/0000-0002-5138-3617
D.A. Svirskii
Northern State Medical University, Arkhangelsk, Russia
https://orcid.org/0000-0001-5798-9209
Mihail Yu. Kirov
Volosevich First City Clinical Hospital, Arkhangelsk, Russia; Northern State Medical University, Arkhangelsk, Russia
https://orcid.org/0000-0002-4375-3374
#3 2022
PDF_2022-3_57-68 (Russian)
HTML_2022-3_57-68 (Russian)

Keywords

diaphragm
phrenic nerve
electrostimulation
ventilator weaning

How to Cite

1.
Paromov K.V., Svirskii D.A., Kirov M.Y. Treatment option for diaphragm dysfunction after cardiac surgery: a review and a clinical case. Annals of Critical Care. 2022;(3):57-68. doi:10.21320/1818-474X-2022-3-57-68
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver

Download Citation

Endnote/Zotero/Mendeley (RIS) BibTeX

Statistic

Abstract Views: 204
PDF_2022-3_57-68 (Russian) Downloads: 80
HTML_2022-3_57-68 (Russian) Downloads: 602
Statistic from 01.07.2024

Language

English Русский

Most reader

Social Networks

Abstract

INTRODUCTION. Dysfunction of diaphragm postoperatively is associated with worsened quality of life and increased health care costs due to prolonged respiratory support and morbidity. After cardiac operations, dysfunction of diaphragm can take place in up to 10 % of patients but often remains underdiagnosed. At the same time, histologically revealed changes, such as muscle atrophy in the diaphragm, start within 12 hours of mechanical ventilation. The therapy of diaphragm weakness is not well established and has a limited efficacy. Current analytic review describes therapeutic option for treatment ventilator-induced diaphragm dysfunction with emphasis on electric neuromodulation of phrenic nerve. OBJECTIVE. To optimize respiratory function by bilateral electrostimulation of phrenic nerves on the neck level in patient with diaphragm dysfunction after cardiac operation. MATERIALS AND METHODS. 82-year-old female patient after elective aortic valve replacement was diagnosed with dysfunction of diaphragm and respiratory failure. These changes caused the weaning failure from respirator and led to prolonged ventilator support. On the 20, 22, 24 and 26 days of postoperative period we performed invasive bilateral phrenic nerve stimulation on the neck level for 10 minutes with ultrasound navigation. RESULTS. After electrical modulation of phrenic nerves, diaphragm excursion, detected by ultrasound, was improved. After four procedures, duration of spontaneous breathing trial increased from 1 to 12 hours. On postoperative day 30, the patient was successfully weaned from respiratory support and decannulated without recurrent respiratory failure. There were no any complications during procedure, it was well-tolerated and associated with emotional improvement. CONCLUSIONS. Phrenic nerve stimulation on the neck level can be a valuable option in selected patients with respiratory failure and difficulties with ventilator weaning.

PDF_2022-3_57-68 (Russian)
HTML_2022-3_57-68 (Russian)

References

  1. Vassilakopoulos T., Petrof B.J. Ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2004; 169(3): 336–41. DOI: 10.1164/rccm.200304-489CP
  2. Dot I., Perez-Teran P., Samper M.-A., et al. Disfuncion diafragmatica: una realidad en le paciente ventilado mecanicamente. Arch Bronconeumol. 2017; 53: 150–6.
  3. Liu Y.-Y., Li L.-F. Ventilator-induced diaphragm dysfunction in critical illness. Exp Bio Med (Maywood). 2018; 243: 1329–37. DOI: 10.1177/1535370218811950
  4. Aguirre V.J., Sinha P., Zimmet A., et al. Phrenic nerve injury during cardiac surgery: mechanisms, management and prevention. Heart Lung Circ. 2013; 22(11): 895–902. DOI: 10.1016/j.hlc.2013.06.010
  5. Базылев В.В., Парамонова Т.И., Вдовкин А.В. Анализ положения и подвижности диафрагмы у взрослых с нормальной функцией легких до и после кардиохирургических вмешательств. Лучевая диагностика и терапия. 2017; (1): 53–63. DOI: 10.22328/2076-5343-2017-1-53-63 [Bazylev V.V., Paramonova T.I., Vdovkin A.V. Analysys of the position and mobility of the diaphragm in adults with normal lung function before and after cardiac surgery. Diagnostic radiology and radiotherapy. 2017; (1): 53–63. DOI: 10.22328/2076-5343-2017-1-53-63 (In Russ)]
  6. Laghlam D., Pierre Le M., Srour A., et al. Diaphragm dysfunction after cardiac surgery: reappraisal. J Cardiothorac Vasc Anesth. 2021; 35(11): 3241–7. DOI: 10.1053/j.jvca.2021.02.023
  7. Merino-Ramirez M.A., Juan G., Ramon M., et al. Electrophysiological evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: prospective study of diabetes and other risk factors. J Thorac Cardiovasc Surg. 2006; 132(3): 530–6.
  8. Huang M.C., Lu H.M., Chen L., et al. Cost per QALY (quality-adjusted life year) and lifetime cost of prolonged mechanical ventilation in Taiwan. PLoSOne. 2012; 7: e44043. DOI: 10.1371/journal.pone.0044043
  9. Fayssoil A., Mansencal N., Nguyen L.S., et al. Diaphragm ultrasound in cardiac surgery: state of art. Medicines (Basel). 2022; 9(1): 5. DOI:10.3390/medicines9010005
  10. Carrillo-Esper R., Perez-Calatayud A.A., Arch-Tirado E., et al. Standardization of sonographic diaphragm thickness evaluations in healthy volunteers. Respir Care. 2016; 61(7): 920–4. DOI:10.4187/respcare.03999
  11. Hanna L.M., De Losa R., Romeo N., Muruganandan S. Diaphragm dysfunction: a comprehensive review from diagnosis to management. Intern Med J. 2021. DOI:10.1111/imj.15491
  12. Dres M., Goligher E.C., Heunks L.M.A., Brochart L.J. Critical illness-associated diaphragm weakness. Intensive Care Med. 2017; 43(10):1441–52. DOI: 10.1007/s00134-017-4928-4
  13. Kim W.-Y., Lim C.-M. Ventilator-Induced Diaphragmatic dysfunction: Diagnosis and role of pharmacological agents. Respir Care. 2017; 62(11): 1485–91. DOI: 10.4187/respcare.05622
  14. Agten A., Maes K., Smuder A., et al. N-Acetylcystein protects the rat diaphragm from the decreased contractility associated with controlled mechanical ventilation. Crit Care Med. 2011; 39(4): 777–82. DOI: 10.1097/CCM.0b013e318206cca9
  15. Doorduin J., Sinderby C.A., Beck J., et al. The calcium sensitizer levosimendan improves human diaphragm function. Am J Respir Crit Care Med. 2012; 185(1): 90–5. DOI: 10.1164/rccm.201107-1268OC
  16. Schellekens W.-J.M., van Hees H.W.H., Linkels M., et al. Levosimendan affects oxidative and inflammatory pathways in the diaphragm of ventilated endotoxemic mice. Crit Care. 2015; 19(1): 69. DOI: 10.1186/s13054-015-0798-8
  17. Бабаев М.А., Быков Д.Б., Бирг Т.М. и др. ИВЛ-индуцированная дисфункция диафрагмы (обзор). Общая реаниматология. 2018; 14(3): 82–103. DOI:15360/1813-9779-2018-3-82-103 [Babaev M.A., Bykov D.B., Birg T.M., et al. Ventilator-induced diaphragm dysfunction (Review). General Reanimatology. 2018; 14(3): 82–103. DOI: 10.15360/1813-9779-2018-3-82-103 (In Russ)]
  18. Hutson T.H., Giovanni S.D. The translational landscape in spinal cord injury: focus on neuroplasticity and regeneration. Nat Rev Neurol. 2019; 15(12): 732–45. DOI: 10.1038/s41582-019-0280-3
  19. Zhang H., Liu Y., Zhou K., et al. Restoring sensorimotor function through neuromodulation after spinal cord injury: progress and remaining challenges. Front Neurosci. 2021; 15: 749465. DOI: 10.3389/fnins.2021.749465
  20. Ottestad E., Orlovich D.S. History of Peripheral Nerve Stimulation — Update for the 21st Century. Pain Med. 2020; 21(Suppl. 1): S3–S5. DOI: 10.1093/pm/pnaa165
  21. Thompson D.M., Koppes A.N., Hardy J.G., Schmidt C.E. Electrical stimuli in the central nervous system microenvironment. Annu Rev Biomed Eng. 2014; 16: 397–430. DOI: 10.1146/annurev-biogen-121813-120655
  22. Войтенков В.Б., Команцев В.Н., Екушева Е.В. и др. Комплексное нейрофизиологическое и ультразвуковое исследование диафрагмального нерва в норме и при различных патологических состояниях. Российский неврологический журнал. 2019; 24(3): 5–9. DOI: 30629/2658-7947-2019-24-3-5-9 [Voitenkov V.B., Komantsev V.N., Ekusheva E.V., et al. Neurophysiology and ultrasound in the evaluation of phrenic nerve in normal and pathologic conditions. Russian Neurological Journal (Rossiyskiy Nevrologicheskiy Zhurnal). 2019; 24(3): 5–9 (In Russ)] DOI: 10.30629/2658-7947-2019-24-3-5-9
  23. Albrecht E., Kirkham K.R., Taffe P., et al. The maximum effective needle-to-nerve distance for ultrasound-guided interscalene block: an exploratory study. Reg Anesth Pain Med. 2014; 39(1): 56–60.
  24. Dalrymple P., Chelliah S. Electrical nerve locators. Continuing Education in Anesthesia Critical Care & Pain. 2006; 6(1): 32–6. DOI: 10.1093/bjaceaccp/mki065
  25. Deer T., Naidu R., Strand N., et al. A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions. Bioelectron Med. 2020; 6: 9. DOI: 10.1186/s42234-020-00045-5
  26. Hirschfeld S., Luukkaala E.G., Baer G.A. Mechanical ventilation or phrenic nerve stimulation for treatment of spinal cord injury-induced respiratory insufficiency. Spinal Cord. 2008; 46(11): 738– DOI: 10.1038/sc.2008.43
  27. Khasawneh M., Silverman E., Tornatore M., et al. Transvenous diaphragmatic neurostimulator to assist ventilator weaning in hospitalized patients with COVID-19. Chest. 2021; 160(4): A1041. DOI 10.1016/j.chest.2021.07.965
  28. Onders R., Markovitz A., Ho V.P., et al. Completed FDA feasibility trial of surgical placed temporary diaphragm pacing electrodes: A promising option to prevent and treat respiratory failure. Am J Surg. 2018; 215(3): 518–21. DOI: 10.1016/j.amsurg.2017.10.054
  29. Headley D.B., Martins A.G., McShane K.J., et al. Diaphragm pacing using the minimally invasive cervical approach. J Spinal Cord Med. 2021; 7: 1–9. DOI:10.1080/10790268/2021/1940794
  30. Padmanaban V., Payne R., Corbani K., et al. Phrenic nerve stimulator placement via the cervical approach: technique and anatomic considerations. Oper Neurosurg (Hagerstown). 2021; 21(3): E215–E220. DOI: 10.1093/ons/opab047
  31. Dube B.-P., Dres M. Diaphragm dysfunction: diagnostic approaches and management strategies. J Clin Med. 2016; 5(12):113. DOI 10.3390/jcm5120113.
  32. Шарова Н.В., Черкашин Д.В., Макиев Р.Г. и др. Одышка в практике терапевта: развитие пареза диафрагмы у больного бронхиальной астмой. Доктор.Ру. 2021; 20(11): 77–81. DOI: 10.31550/1727-2378-2021-20-11-77-81 [Sharova N.V., Cherkashin D.V., Makiev R.G., et al. Dyspnoe in General Medicine: Diaphragm Paresis in a patient with bronchial asthma. Doctor.Ru. 2021; 20(11): 77–81. DOI: 10.31550/1727-2378-2021-20-11-77-81 (In Russ)]
  33. Мищук Н.Е. Нарушения функции диафрагмы. Ліки України. Medicine of Ukraine. 2016; 7–8(203–204): 48–54. [Mishhuk N.E. Diaphragm function disturbances. Ліки України. Medicine of Ukraine. 2016; 7–8(203–204): 48–54. (In Russ)]
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Copyright (c) 2022 ANNALS OF CRITICAL CARE

Most read articles by the same author(s)