Diaphragmatic Dysfunction after Thoracic Operations

Henning Gaissert; Susan R. Wilcox

doi:10.1055/s-0036-1595816

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Thorac Cardiovasc Surg 2016; 64(08): 621-630
DOI: 10.1055/s-0036-1595816

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Diaphragmatic Dysfunction after Thoracic Operations

Henning Gaissert

¹Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States

,

Susan R. Wilcox

²Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, United States

› Institutsangaben

Abstract

Alle Artikel dieser Rubrik

Abstract

The perioperative management of diaphragmatic weakness and phrenic nerve dysfunction is complex, due to varied etiologies and clinical presentations. The factors leading to diaphragmatic weakness may culminate after the operation with transient or persistent respiratory failure. This review discusses diaphragmatic disorders and postoperative respiratory failure caused by unilateral or bilateral diaphragmatic impairment. The origins of neuromuscular weakness involving the diaphragm are diverse, and often lie within the domains of different medical specialties, with only a portion of the condition related to surgical intervention. Consideration of underlying etiologies for any individual patient requires thorough multidisciplinary review. The most important clinical scenarios compounding diaphragmatic weakness, including acute myasthenic states, persistent neuromuscular blockade, and surgical injury to the phrenic nerve or diaphragm, are accessible to attentive surgeons. Awareness of the signs and symptoms of undiagnosed weakness, preoperative pursuit of its diagnosis, knowledge of surgical alternatives to phrenic nerve resection, and cooperative skills in the multidisciplinary management of myasthenia all are crucial to improve patient outcomes.

Keywords

diaphragm - myasthenia - respiratory failure - thymoma - neuromuscular disease

Volltext

Referenzen

References
1 Rochester DF, Arora NS. Respiratory muscle failure. Med Clin North Am 1983; 67 (3) 573-597
2 Roussos C. Function and fatigue of respiratory muscles. Chest 1985; 88 (2, Suppl): 124S-132S
3 Whitelaw WA. Shape and size of the human diaphragm in vivo. J Appl Physiol (1985) 1987; 62 (1) 180-186
4 Gibson GJ. Diaphragmatic paresis: pathophysiology, clinical features, and investigation. Thorax 1989; 44 (11) 960-970
5 Ugalde P, Miro S, Provencher S , et al. Ipsilateral diaphragmatic motion and lung function in long-term pneumonectomy patients. Ann Thorac Surg 2008; 86 (6) 1745-1751 , discussion 1751–1752
6 Merendino KA, Johnson RJ, Skinner HH, Maguire RX. The intradiaphragmatic distribution of the phrenic nerve with particular reference to the placement of diaphragmatic incisions and controlled segmental paralysis. Surgery 1956; 39 (1) 189-198
7 Fratacci MD, Kimball WR, Wain JC, Kacmarek RM, Polaner DM, Zapol WM. Diaphragmatic shortening after thoracic surgery in humans. Effects of mechanical ventilation and thoracic epidural anesthesia. Anesthesiology 1993; 79 (4) 654-665
8 Macklem PT, Roussos CS. Respiratory muscle fatigue: a cause of respiratory failure?. Clin Sci Mol Med 1977; 53 (5) 419-422
9 Macklem PT. Muscular weakness and respiratory function. N Engl J Med 1986; 314 (12) 775-776
10 Rochester DF, Esau SA. Assessment of ventilatory function in patients with neuromuscular disease. Clin Chest Med 1994; 15 (4) 751-763
11 Zou J, Su C, Lun X , et al. Preoperative anxiety in patients with myasthenia gravis and risk for myasthenic crisis after extended transsternal thymectomy: A CONSORT study. Medicine (Baltimore) 2016; 95 (10) e2828
12 Mier A, Laroche C, Green M. Unsuspected myasthenia gravis presenting as respiratory failure. Thorax 1990; 45 (5) 422-423
13 Sakuraba M, Onuki T, Nitta S. Measurement of antiacetylcholine receptor antibody in patients with thymoma without myasthenia gravis complications. Jpn J Thorac Cardiovasc Surg 2001; 49 (12) 690-692
14 Laroche CM, Mier AK, Spiro SG, Newsom-Davis J, Moxham J, Green M. Respiratory muscle weakness in the Lambert-Eaton myasthenic syndrome. Thorax 1989; 44 (11) 913-918
15 Weingarten TN, Araka CN, Mogensen ME , et al. Lambert-Eaton myasthenic syndrome during anesthesia: a report of 37 patients. J Clin Anesth 2014; 26 (8) 648-653
16 Donaldson AV, Maddocks M, Martolini D, Polkey MI, Man WD. Muscle function in COPD: a complex interplay. Int J Chron Obstruct Pulmon Dis 2012; 7: 523-535
17 Stassijns G, Lysens R, Decramer M. Peripheral and respiratory muscles in chronic heart failure. Eur Respir J 1996; 9 (10) 2161-2167
18 Laroche CM, Mier AK, Moxham J, Green M. Diaphragm strength in patients with recent hemidiaphragm paralysis. Thorax 1988; 43 (3) 170-174
19 Laroche CM, Carroll N, Moxham J, Green M. Clinical significance of severe isolated diaphragm weakness. Am Rev Respir Dis 1988; 138 (4) 862-866
20 Piehler JM, Pairolero PC, Gracey DR, Bernatz PE. Unexplained diaphragmatic paralysis: a harbinger of malignant disease?. J Thorac Cardiovasc Surg 1982; 84 (6) 861-864
21 Polkey MI, Green M, Moxham J. Measurement of respiratory muscle strength. Thorax 1995; 50 (11) 1131-1135
22 Jiao W, Zhao Y, Wang M , et al. A retrospective study of diaphragmatic motion, pulmonary function, and quality-of-life following video-assisted thoracoscopic lobectomy in patients with nonsmall cell lung cancer. Indian J Cancer 2015; 51 (Suppl. 02) e45-e48
23 Allen SM, Hunt B, Green M. Fall in vital capacity with posture. Br J Dis Chest 1985; 79 (3) 267-271
24 Heliopoulos I, Patlakas G, Vadikolias K , et al. Maximal voluntary ventilation in myasthenia gravis. Muscle Nerve 2003; 27 (6) 715-719
25 Elsais A, Johansen B, Kerty E. Airway limitation and exercise intolerance in well-regulated myasthenia gravis patients. Acta Neurol Scand Suppl 2010; (190) 12-17
26 Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M. Assessment of diaphragm weakness. Am Rev Respir Dis 1988; 137 (4) 877-883
27 Steier J, Kaul S, Seymour J , et al. The value of multiple tests of respiratory muscle strength. Thorax 2007; 62 (11) 975-980
28 Goligher EC, Laghi F, Detsky ME , et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med 2015; 41 (4) 734
29 Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest 2008; 133 (3) 737-743
30 Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J 2014; 6 (1) 8
31 Kim SH, Na S, Choi JS, Na SH, Shin S, Koh SO. An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesth Analg 2010; 110 (5) 1349-1354
32 Racca F, Mongini T, Wolfler A , et al. Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders. Minerva Anestesiol 2013; 79 (4) 419-433
33 Birnkrant DJ, Panitch HB, Benditt JO , et al. American College of Chest Physicians consensus statement on the respiratory and related management of patients with Duchenne muscular dystrophy undergoing anesthesia or sedation. Chest 2007; 132 (6) 1977-1986
34 Blichfeldt-Lauridsen L, Hansen BD. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand 2012; 56 (1) 17-22
35 Pitts T, Bolser D, Rosenbek J, Troche M, Okun MS, Sapienza C. Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest 2009; 135 (5) 1301-1308
36 Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest 2000; 118 (5) 1390-1396
37 Bach JR, Smith WH, Michaels J , et al. Airway secretion clearance by mechanical exsufflation for post-poliomyelitis ventilator-assisted individuals. Arch Phys Med Rehabil 1993; 74 (2) 170-177
38 Vianello A, Arcaro G, Braccioni F , et al. Prevention of extubation failure in high-risk patients with neuromuscular disease. J Crit Care 2011; 26 (5) 517-524
39 Cardone A, Congedo E, Aceto P , et al. Perioperative evaluation of myasthenia gravis. Ann Ital Chir 2007; 78 (5) 359-365
40 Jamal BT, Herb K. Perioperative management of patients with myasthenia gravis: prevention, recognition, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107 (5) 612-615
41 Watanabe A, Watanabe T, Obama T , et al. Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis. J Thorac Cardiovasc Surg 2004; 127 (3) 868-876
42 Yano M, Sasaki H, Moriyama S , et al. Preservation of phrenic nerve involved by stage III thymoma. Ann Thorac Surg 2010; 89 (5) 1612-1619
43 Hamdi S, Mercier O, Fadel E , et al. Is sacrifying the phrenic nerve during thymoma resection worthwhile?. Eur J Cardiothorac Surg 2014; 45 (5) e151-e155
44 Tokunaga T, Sawabata N, Kadota Y , et al. Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery. Eur J Cardiothorac Surg 2010; 38 (5) 600-603
45 Ohta M, Ikeda N, Tanaka H, Matsumura A, Ohsumi H, Iuchi K. Satisfactory results of diaphragmatic plication for bilateral phrenic nerve paralysis. Ann Thorac Surg 2007; 84 (3) 1029-1031
46 Beattie GW, Dunn WG, Asif M. In patients with a tumour invading the phrenic nerve does prophylactic diaphragm plication improve postoperative lung function?. Interact Cardiovasc Thorac Surg 2016; 23 (3) 454-458
47 D'Andrilli A, Ibrahim M, Andreetti C, Ciccone AM, Venuta F, Rendina EA. Transdiaphragmatic harvesting of the omentum through thoracotomy for bronchial stump reinforcement. Ann Thorac Surg 2009; 88 (1) 212-215
48 Lardinois D, Horsch A, Krueger T, Dusmet M, Ris HB. Mediastinal reinforcement after induction therapy and pneumonectomy: comparison of intercostal muscle versus diaphragm flaps. Eur J Cardiothorac Surg 2002; 21 (1) 74-78
49 Schoeller T, Ohlbauer M, Wechselberger G, Piza-Katzer H, Margreiter R. Successful immediate phrenic nerve reconstruction during mediastinal tumor resection. J Thorac Cardiovasc Surg 2001; 122 (6) 1235-1237
50 Kaufman MR, Elkwood AI, Rose MI , et al. Reinnervation of the paralyzed diaphragm: application of nerve surgery techniques following unilateral phrenic nerve injury. Chest 2011; 140 (1) 191-197
51 Grant RP, Jenkins LC. Prediction of the need for postoperative mechanical ventilation in myasthenia gravis: thymectomy compared to other surgical procedures. Can Anaesth Soc J 1982; 29 (2) 112-116
52 Fortier LP, McKeen D, Turner K , et al. The RECITE study: a Canadian prospective, multicenter study of the incidence and severity of residual neuromuscular blockade. Anesth Analg 2015; 121 (2) 366-372
53 Abad-Gurumeta A, Ripollés-Melchor J, Casans-Francés R , et al; Evidence Anaesthesia Review Group. A systematic review of sugammadex vs neostigmine for reversal of neuromuscular blockade. Anaesthesia 2015; 70 (12) 1441-1452
54 Lipshutz AK, Gropper MA. Acquired neuromuscular weakness and early mobilization in the intensive care unit. Anesthesiology 2013; 118 (1) 202-215
55 De Jonghe B, Sharshar T, Lefaucheur JP , et al; Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002; 288 (22) 2859-2867
56 De Jonghe B, Sharshar T, Hopkinson N, Outin H. Paresis following mechanical ventilation. Curr Opin Crit Care 2004; 10 (1) 47-52
57 de Jonghe B, Lacherade JC, Sharshar T, Outin H. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med 2009; 37 (10, Suppl): S309-S315
58 Petrof BJ, Hussain SN. Ventilator-induced diaphragmatic dysfunction: what have we learned?. Curr Opin Crit Care 2016; 22 (1) 67-72
59 Bruells CS, Bergs I, Rossaint R , et al. Recovery of diaphragm function following mechanical ventilation in a rodent model. PLoS One 2014; 9 (1) e87460
60 Thomas D, Maes K, Agten A , et al. Time course of diaphragm function recovery after controlled mechanical ventilation in rats. J Appl Physiol (1985) 2013; 115 (6) 775-784
61 Powers SK, Shanely RA, Coombes JS , et al. Mechanical ventilation results in progressive contractile dysfunction in the diaphragm. J Appl Physiol (1985) 2002; 92 (5) 1851-1858
62 Sassoon CS, Caiozzo VJ, Manka A, Sieck GC. Altered diaphragm contractile properties with controlled mechanical ventilation. J Appl Physiol (1985) 2002; 92 (6) 2585-2595
63 Yang L, Luo J, Bourdon J, Lin MC, Gottfried SB, Petrof BJ. Controlled mechanical ventilation leads to remodeling of the rat diaphragm. Am J Respir Crit Care Med 2002; 166 (8) 1135-1140
64 Levine S, Nguyen T, Taylor N , et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008; 358 (13) 1327-1335
65 Jaber S, Jung B, Matecki S, Petrof BJ. Clinical review: ventilator-induced diaphragmatic dysfunction--human studies confirm animal model findings!. Crit Care 2011; 15 (2) 206
66 Grosu HB, Lee YI, Lee J, Eden E, Eikermann M, Rose KM. Diaphragm muscle thinning in patients who are mechanically ventilated. Chest 2012; 142 (6) 1455-1460
67 Jaber S, Petrof BJ, Jung B , et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med 2011; 183 (3) 364-371
68 Andriolo BN, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 2015; 1: CD007271