[Diaphragmatic paralysis and respiratory insufficiency].
BACKGROUND
Phrenic nerve palsy leads to disfunction of the main respiratory muscle. With bilateral palsy dyspnoea in the supine body position will typically occur. With one-sided lesion symptoms will only appear when a second pulmonary disease is present.


METHODS
We refer of 6 patients with bilateral and 5 with unilateral diaphragmatic paresis. In 3 patients neuralgic shoulder-arm-amyotrophy was diagnosed, in further 4 there was suspicion of it. Amyotrophic lateral sclerosis developed in 2 after 4 respectively 8 months. In 1 case a cervical operation led to palsy, mediastinitis in 1 case. Lung function tests showed a restrictive pattern, especially in bilateral palsy.


RESULTS
Vital capacity was reduced by almost 50% respectively 25% in the supine body position. Mouth occlusion pressure reduction was apparent. Near normal to marked hyperkapnia developed in bilateral paresis. In 5 cases non-invasive intermittent ventilation is instituted (2 volume controlled, 3 pressure supported). Two patients died (1 patient with amyotrophic lateral sclerosis after 13 months, 1 with malignant pleurisy after 4 months). Three patients continued non-invasive intermittent ventilation since 14 to 64 months.
Wiebel
M
M
Abteilung Innere Medizin-Pneumologie, Thoraxklinik Heidelberg-Rohrbach.
Jackowski
M
M
Schulz
V
V
D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012133:Respiratory Paralysis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
D002245:Carbon Dioxide