Diaphragmatic paralysis

Diaphragmatic paralysis

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
The respiratory system functions as a vital pump that moves the air inside and outside the lungs. Respiratory pump consists of the central respiratory centers, spinal cord, peripheral nerves, neuromuscular jonctunile and respiratory muscles.
Diaphragm muscle of ventilation most important, develop negative intrathoracic pressure to initiate ventilation. Motor neurons innervated by cervical nerves C3-5 via chest muscle cone graft by decreasing pressure during thoracic cage volume increases respiration and thus facilitates the movement of gases in the lungs.
Unilateral diaphragmatic paralysis in children occurs most often by accidental damage during cardiac surgery phrenic nerve with an incidence of between 0. 3 and 1. 6%. incidence is slightly higher than open-heart procedures in the heart closed. In almost doubles the risk of reinterventions. Most injuries are temporary, about 84%.
Diaphragmatic paralysis in adults is most common on the left side during cardiac surgery by using ice (hypothermia), but also through injuries caused by electrocautery or by direct trauma. Lung inflation, in the case of opening the pleura, phrenic nerve to avoid contact with those of ice has fallen below 2% incidence of diaphragmatic paralysis. Paralysis may be permanent in 15-25% of cases. Idiopathic diaphragmatic paralysis occurs in adults and is usually unilateral, but cases have been reported bilateralitate.
In infants and small children initial treatment is mechanical ventilation including PEEP, possibly with the patient in lateral decubitus position changes on the affected side. If ventilatory support is needed more than two weeks plicaturare surgery is recommended to avoid pulmonary complications of prolonged ventilation. Neurogenic amyotrophy bilateral diaphragmatic paralysis can be treated by surgical diaphragmatic frenoplicatura. In bilateral diaphragmatic paralysis have been reported idiopathic good ventilation using intermittent external negative-positive.
In children and adults is recommended for treatment of paralysis of the diaphragm vonservator, surgical correction is indicated in patients with persistent symptoms, especially with impaired respiratory function. It was practiced for violating plicaturarea videoasistata traumatic diaphragmatic phrenic nerve posttraumatism diagnosed immediately.
Pathology and causes: Diaphragmatic paralysis includes a spectrum of diseases that involve a single event known as unilateral diaphragmatic paralysis, and if it involves both hemidiafragmuri is bilateral. Although the diaphragm performs most of the labor, normal ventilation also requires the contraction of accessory respiratory muscles simulatna (scalenii, parasternal portion of the internal and external intercostal muscles, sternocleidomastoid, trapezius). In bilateral diaphragmatic paralysis accessory respiratory muscles play a role in breathing through the contractions more intense. An intense effort in breathing muscles may tire accessories and leads to respiratory failure.
Causes and risk factors: Unilateral diaphragmatic paralysis: -Most common cause is diagnosed malignant (metastatic lung cancer) lesions lead to nerve compression (approximately 30% of patients) -If not the cause of malignant etiology often is not specified -Other causes include surgical trauma, herpes zoster, cervical spondylosis. Diafrgmatica bilateral paralysis: -Most common cause is secondary to motor neurone disease, including amyotrophic lateral sclerosis and postpolio syndrome -Other causes include thoracic trauma, multiple sclerosis, myopathies and muscular dystrophy.