Incidence and management of diaphragmatic palsy in patients after cardiac surgery.
BACKGROUND
Diaphragm is the most important part of the respiratory system. Diaphragmatic palsy following cardiac surgery is not uncommon and can cause deterioration of pulmonary functions and attendant pulmonary complications.


OBJECTIVE
Aim of this study was to observe the incidence of diaphragmatic palsy after off pump coronary artery bypass grafting (OPCAB) as compared to conventional CABG and to assess the efficacy of chest physiotherapy on diaphragmatic palsy in post cardiac surgical patients.


METHODS
An observational prospective interventional study done at a tertiary care cardiac centre.


METHODS
2280 consecutive adult patients who underwent cardiac surgery from February 2005 to august 2005.


RESULTS
30 patients out of 2280 (1.31%) developed diaphragmatic palsy. Patients were divided based on the presence or absence of symptoms viz. breathlessness at rest or exertion or with the change of posture along with hypoxemia and / or hypercapnia. Group I included 14 patients who were symptomatic (CABG n=13, post valve surgery n=1), While Group II included 16 asymptomatic patients (CABG n=12, post valve surgery n=4), 9 patients (64%) from Group I (n=14) and 4 patients (25%) from group II showed complete recovery from diaphragmatic palsy as demonstrated ultrasonographically.


CONCLUSIONS
The incidence of diaphragmatic palsy was remarkably less in our adult cardiac surgical patients because most of the cardiac surgeries were performed off pump and intensive chest physiotherapy beginning shortly after extubation helped in complete or near complete recovery of diaphragmatic palsy. Chest Physiotherapy led to marked improvement in functional outcome following post cardiac surgery diaphragmatic palsy. We also conclude that ultrasonography is a simple valuable bed-side tool for rapid diagnosis of diaphragmatic palsy.
Mehta
Yatin
Y
Department of Anesthesia and Critical Care, Physiotherapy and Cardiac Surgery, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi. yatinmehta@hotmail.com
Vats
Mayank
M
Singh
Ajmer
A
Trehan
Naresh
N