Spontaneous recovery of diaphragmatic strength in unilateral diaphragmatic paral

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Respir Med. 2006 Apr 15

Spontaneous recovery of diaphragmatic strength in unilateral

diaphragmatic paralysis.

Verin E, Marie JP, Tardif C, Denis P.

Service de Physiologie digestive, urinaire, respiratoire et sportive,

CHU de ROUEN-1 rue de Germont, 76031 ROUEN Cedex, France; GRHV, EA 38

30, Research Group, IFRMP 23, Universite de Rouen, France.

The aim of the present study was to evaluate diaphragmatic strength

in patients with unilateral diaphragmatic paralysis and to determine

whether patients with recent diaphragm paralysis develop lower

inspiratory pressure than patients with longstanding diaphragmatic

paralysis. Twenty patients (16 men and 4 women, 62+/-12 years) and

six control subjects were included (4 men and 2 women, 53+/-15 years)

in the study. Esophageal pressure during sharp sniff (Pes,sniff),

bilateral cervical phrenic nerve magnetic stimulation (Pes,cms) and

unilateral phrenic nerve stimulation (Pes,ums) (in nine patients)

were measured. Sixteen patients presented right diaphragmatic

paralysis and four, left diaphragmatic paralysis. Pes,sniff was

higher in control subjects than in patients with diaphragmatic

paralysis (respectively 110+/-22cmH(2)O and 82+/-24cmH(2)O, P<0.05).

There was no difference in Pes,cms between patients with

diaphragmatic paralysis and control subjects (14+/-7cmH(2)O vs. 16+/-

4cmH(2)O; ns). Pes,ums after stimulation of the affected phrenic

nerve was less than 4cmH(2)O, was 8+/-2cmH(2)O after stimulation of

the intact phrenic nerve and was correlated to Pes,cms (R=0.87,

P<0.01). There was a positive correlation between Pes,cms, Pes,ums of

the intact hemidiaphragm, Pes,sniff and the time from the onset of

symptoms and the diaphragmatic explorations (respectively R=0.86,

P<0.0001; R=0.72, P<0.05; R=0.48, P<0.05).

In conclusion, diaphragmatic strength after unilateral diaphragmatic

paralysis seems to improve with time.