Association of chest tube position with phrenic nerve palsy after neonatal and infant cardiac surgery

BackgroundDiaphragm paralysis (DP) complicates the postoperative course of neonates and infants undergoing cardiac surgery. Events causing DP remain poorly understood, preventive strategies elusive. This retrospective cohort analysis aims to test hypothesis that chest tubes in contact with phrenic nerve pleural apex may cause pressure palsy.MethodsIn late 2018, tube positioning strategy was changed so as avoid a putative “danger zone” configuration, defined (1) looping apicomedially at level second right intercostal space, (2) wedging tip against pericardium. A preintervention postintervention 531 patients from 2012 2019 performed evaluate any association position or duration place DP. Univariable multivariable analyses were carried out, significance set priori P < .05.ResultsThe group comprised 488 patients, whom 32 (6.6%) had RDP. The 43 none Multivariable entire revealed danger zone only significant RDP (odds ratio, 4.22; 95% confidence interval, 1.57-11.33; .05).ConclusionsChest occupy superior space are associated increased risk