Role of topical application of iced slush in the development of phrenic nerve palsy after cardiac surgery

Background/Introduction Phrenic nerve palsy (PNP) is a well-recognized complication after cardiac surgery which might occur as a result of topical myocardial cooling, direct injury or ischemia. It can result in deleterious respiratory effects especially in children and in patient with chronic obstructive pulmonary disease which adversely affect recovery and increase the length of ICU and hospital stay. Topical application of iced slush has been used for decades in hypothermic cardiac surgery, the effect of the direct contact between the iced slush and phrenic nerve might increase the incidence of nerve palsy and diaphragmatic dysfunction. Recently normothermic cardiac surgery has been employed largely to avoid the adverse effects of hypothermia.