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

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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.	罗丹东, 陈寄梅, 岑坚正, 等. 先天性心脏病术后膈肌麻痹的诊断和处理. 中华小儿外科杂志, 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.	欧阳辉, 邬晓臣, 丁盛, 等. 膈肌折叠术治疗婴幼儿先天性心脏病矫治术后膈肌麻痹的临床疗效分析. 中国胸心血管外科临床杂志, 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, 李守军, 吕小东, 等. 婴幼儿心脏手术后膈肌麻痹的超声诊断. 中国超声医学杂志, 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.	张燕搏, 王旭, 李守军, 等. 儿童先天性心脏病术后膈肌麻痹的临床研究. 中华实用诊断与治疗杂志, 2011, 25(12): 1152-1153.
14.	王顺民, 徐志伟, 苏肇伉, 等. 先天性心脏病矫治术后膈肌麻痹的诊断与治疗. 中国胸心血管外科临床杂志, 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. 罗丹东, 陈寄梅, 岑坚正, 等. 先天性心脏病术后膈肌麻痹的诊断和处理. 中华小儿外科杂志, 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. 欧阳辉, 邬晓臣, 丁盛, 等. 膈肌折叠术治疗婴幼儿先天性心脏病矫治术后膈肌麻痹的临床疗效分析. 中国胸心血管外科临床杂志, 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, 李守军, 吕小东, 等. 婴幼儿心脏手术后膈肌麻痹的超声诊断. 中国超声医学杂志, 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. 张燕搏, 王旭, 李守军, 等. 儿童先天性心脏病术后膈肌麻痹的临床研究. 中华实用诊断与治疗杂志, 2011, 25(12): 1152-1153.
14. 王顺民, 徐志伟, 苏肇伉, 等. 先天性心脏病矫治术后膈肌麻痹的诊断与治疗. 中国胸心血管外科临床杂志, 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.

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

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