Diaphragmatic paralysis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Diaphragmatic paralysis}} | {{Diaphragmatic paralysis}} | ||
{{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] | {{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] | ||
==Overview== | ==Overview== | ||
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==== Unilateral diaphragmatic paralysis ==== | ==== Unilateral diaphragmatic paralysis ==== | ||
* No treatment are required in unilateral diaphragmatic paralysis because most patients are [[asymptomatic]].<ref name="pmid6849536">{{cite journal |vauthors=Easton PA, Fleetham JA, de la Rocha A, Anthonisen NR |title=Respiratory function after paralysis of the right hemidiaphragm |journal=Am. Rev. Respir. Dis. |volume=127 |issue=1 |pages=125–8 |date=January 1983 |pmid=6849536 |doi=10.1164/arrd.1983.127.1.125 |url=}}</ref> | * No treatment are required in unilateral diaphragmatic paralysis because most patients are [[asymptomatic]].<ref name="pmid6849536">{{cite journal |vauthors=Easton PA, Fleetham JA, de la Rocha A, Anthonisen NR |title=Respiratory function after paralysis of the right hemidiaphragm |journal=Am. Rev. Respir. Dis. |volume=127 |issue=1 |pages=125–8 |date=January 1983 |pmid=6849536 |doi=10.1164/arrd.1983.127.1.125 |url=}}</ref> | ||
* Transient ventilatory support with noninvasive positive pressure ventilation (NPPV) or invasive [[mechanical ventilation]]: it is used when patients with unilateral diaphragmatic paralysis develop acute respiratory dysfunction after general | * Transient ventilatory support with noninvasive positive pressure ventilation (NPPV) or invasive [[mechanical ventilation]]: it is used when patients with unilateral diaphragmatic paralysis develop acute respiratory dysfunction after [[General anaesthesia|general anesthesia]] or [[infections]]. | ||
==== Bilateral diaphragmatic paralysis ==== | ==== Bilateral diaphragmatic paralysis ==== | ||
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* Ventilatory support (invasive or noninvasive) | * Ventilatory support (invasive or noninvasive) | ||
* Diaphragmatic pacing: | * Diaphragmatic pacing: | ||
** It is done via stimilation of the diaphragm by implanted electrodes at the level of the neck or thorax. <ref name="pmid27195135">{{cite journal |vauthors=Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM |title=Diaphragm pacing: the state of the art |journal=J Thorac Dis |volume=8 |issue=Suppl 4 |pages=S376–86 |date=April 2016 |pmid=27195135 |pmc=4856845 |doi=10.21037/jtd.2016.03.97 |url=}}</ref> | ** It is done via stimilation of the diaphragm by implanted [[electrodes]] at the level of the neck or thorax. <ref name="pmid27195135">{{cite journal |vauthors=Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM |title=Diaphragm pacing: the state of the art |journal=J Thorac Dis |volume=8 |issue=Suppl 4 |pages=S376–86 |date=April 2016 |pmid=27195135 |pmc=4856845 |doi=10.21037/jtd.2016.03.97 |url=}}</ref> | ||
** It can not be done in patients with denervated diaphragams | ** It can not be done in patients with denervated diaphragams. | ||
** Best candidates for diaphragmatic pacing are patients with high level cervical cord injury.<ref name="pmid19067067">{{cite journal |vauthors=Onders RP, Elmo M, Khansarinia S, Bowman B, Yee J, Road J, Bass B, Dunkin B, Ingvarsson PE, Oddsdóttir M |title=Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients |journal=Surg Endosc |volume=23 |issue=7 |pages=1433–40 |date=July 2009 |pmid=19067067 |doi=10.1007/s00464-008-0223-3 |url=}}</ref> | ** Best candidates for diaphragmatic pacing are patients with high level cervical cord injury.<ref name="pmid19067067">{{cite journal |vauthors=Onders RP, Elmo M, Khansarinia S, Bowman B, Yee J, Road J, Bass B, Dunkin B, Ingvarsson PE, Oddsdóttir M |title=Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients |journal=Surg Endosc |volume=23 |issue=7 |pages=1433–40 |date=July 2009 |pmid=19067067 |doi=10.1007/s00464-008-0223-3 |url=}}</ref> | ||
Revision as of 15:14, 26 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2] [3] [4] [5]
Overview
No treatment is required for unilateral diaphragmatic paralysis because most patients are asymptomatic. In bilateral diaphragmatic paralysis treatment options are ventilatory support and diaphragmatic pacing.
Medical Therapy
Unilateral diaphragmatic paralysis
- No treatment are required in unilateral diaphragmatic paralysis because most patients are asymptomatic.[1]
- Transient ventilatory support with noninvasive positive pressure ventilation (NPPV) or invasive mechanical ventilation: it is used when patients with unilateral diaphragmatic paralysis develop acute respiratory dysfunction after general anesthesia or infections.
Bilateral diaphragmatic paralysis
- Treatment options depends upon the severity of paralysis of the diaphragm and etiology. [2][3]
- Ventilatory support (invasive or noninvasive)
- Diaphragmatic pacing:
- It is done via stimilation of the diaphragm by implanted electrodes at the level of the neck or thorax. [4]
- It can not be done in patients with denervated diaphragams.
- Best candidates for diaphragmatic pacing are patients with high level cervical cord injury.[5]
Diaphragmatic paralysis
Antiviral therapy for viral etiology of diaphragmatic paralysis:[6]
- Adult
- Valacyclovir 1000 mg twice daily for 1 week
References
- ↑ Easton PA, Fleetham JA, de la Rocha A, Anthonisen NR (January 1983). "Respiratory function after paralysis of the right hemidiaphragm". Am. Rev. Respir. Dis. 127 (1): 125–8. doi:10.1164/arrd.1983.127.1.125. PMID 6849536.
- ↑ Davis J, Goldman M, Loh L, Casson M (January 1976). "Diaphragm function and alveolar hypoventilation". Q. J. Med. 45 (177): 87–100. PMID 1062815.
- ↑ Gibson GJ (November 1989). "Diaphragmatic paresis: pathophysiology, clinical features, and investigation". Thorax. 44 (11): 960–70. PMC 462156. PMID 2688182.
- ↑ Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM (April 2016). "Diaphragm pacing: the state of the art". J Thorac Dis. 8 (Suppl 4): S376–86. doi:10.21037/jtd.2016.03.97. PMC 4856845. PMID 27195135.
- ↑ Onders RP, Elmo M, Khansarinia S, Bowman B, Yee J, Road J, Bass B, Dunkin B, Ingvarsson PE, Oddsdóttir M (July 2009). "Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients". Surg Endosc. 23 (7): 1433–40. doi:10.1007/s00464-008-0223-3. PMID 19067067.
- ↑ Crausman RS, Summerhill EM, McCool FD (2009). "Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm?". Lung. 187 (3): 153–7. doi:10.1007/s00408-009-9140-z. PMID 19277778.