Phrenic Nerve Palsy Post-Cardiac Surgery
OVERVIEW
- Phrenic nerve palsy post-cardiac surgery can result from multiple mechanisms and can lead to significant morbidity
CAUSES
- mechanical damage or stretching (dissection, IMA dissection, retraction)
- chest drain irritation
- ischaemia
- topical cooling
- haematoma from IJV puncture
- pre-existing problem
CLINICAL MANIFESTATIONS
- hemidiaphragm palsy more common than bilateral
- respiratory difficulties: hypoxia, increased A-a gradient, unable to wean, persistent collapse, pneumonia
- decreased chest wall movement on affected side
- reduced AE
- dull to percussion
- absence of normal TV
- paradoxical movement with sniff test (fluoroscopy or U/S)
MANAGEMENT
- removed chest drain if not required
- supportive care
- physiotherapy
- NIV
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC