title: Respiratory inductance plethysmography used to diagnose bilateral diaphragmatic paralysis: a case report.
abstract: OBJECTIVE
  To report the use of respiratory inductance plethysmography in the diagnosis and management for a case of bilateral diaphragmatic paralysis after repeated sternotomies in a 23-month-old child.
  
  
  METHODS
  Case report.
  
  
  METHODS
  A 15-bed pediatric cardiothoracic intensive care unit in an academic children's hospital.
  
  
  METHODS
  The patient could not be weaned from the ventilator after a repeat sternotomy for pulmonary artery reconstruction. Pulmonary function test results were within normal limits, and plain film radiography, ultrasonography, and fluoroscopy were unable to establish a definitive diagnosis. Evaluation of thoracoabdominal synchrony was undertaken using respiratory inductance plethysmography (RespiTrace). The work of breathing was assessed using esophageal manometry to obtain the pressure-rate product.
  
  
  RESULTS
  During spontaneous breathing, complete thoracoabdominal asynchrony was noted, with clockwise Konno-Mead loops and associated phase angles of nearly 180 degrees. The pressure-rate product was 120 cm H(2)O/min, indicating elevated work of breathing. The pressure-rate product decreased dramatically, as indicated by measurement and observation, in response to increased levels of continuous positive airway pressure.
  
  
  CONCLUSIONS
  The diagnosis of bilateral diaphragmatic paralysis can be confirmed by measurement of thoracoabdominal synchrony. Therapeutic and diagnostic application of continuous positive airway pressure may predict response to diaphragmatic plication. Controlled trials comparing measurement of thoracoabdominal synchrony with standard methods for the early diagnosis of diaphragmatic paralysis are needed.
authors.affiliation: Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA. bwillis@chla.usc.edu
authors.forename: Brigham C
authors.initials: BC
authors.lastname: Willis
authors.forename: Alan S
authors.initials: AS
authors.lastname: Graham
authors.forename: Randall
authors.initials: R
authors.lastname: Wetzel
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: L  Newth
mesh_terms: D003964:Diaphragm / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D008365:Manometry; D010991:Plethysmography / Q000379:methods*; D012129:Respiratory Function Tests; D012133:Respiratory Paralysis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D014939:Work of Breathing