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

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