Diaphragmatic paralysis medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (Bot: Removing from Primary care)
 
(4 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Diaphragmatic paralysis}}
{{Diaphragmatic paralysis}}
{{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu]
{{CMG}}; {{AE}}{{MA}} [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu] [mailto:malihash@bidmc.harvard.edu]


==Overview==
==Overview==
No treatment are required in unilateral diaphragmatic paralysis because most patients are [[asymptomatic]]. In bilateral diaphragmatic paralysis treatment options are ventilatory support and diaphragmatic pacing.
No treatment is required for unilateral diaphragmatic paralysis because most patients are [[asymptomatic]]. In bilateral diaphragmatic paralysis treatment options are ventilatory support and diaphragmatic pacing.


==Medical Therapy==
==Medical Therapy==
Line 10: Line 10:
==== Unilateral diaphragmatic paralysis ====
==== Unilateral diaphragmatic paralysis ====
* No treatment are required in unilateral diaphragmatic paralysis because most patients are [[asymptomatic]].<ref name="pmid6849536">{{cite journal |vauthors=Easton PA, Fleetham JA, de la Rocha A, Anthonisen NR |title=Respiratory function after paralysis of the right hemidiaphragm |journal=Am. Rev. Respir. Dis. |volume=127 |issue=1 |pages=125–8 |date=January 1983 |pmid=6849536 |doi=10.1164/arrd.1983.127.1.125 |url=}}</ref>  
* No treatment are required in unilateral diaphragmatic paralysis because most patients are [[asymptomatic]].<ref name="pmid6849536">{{cite journal |vauthors=Easton PA, Fleetham JA, de la Rocha A, Anthonisen NR |title=Respiratory function after paralysis of the right hemidiaphragm |journal=Am. Rev. Respir. Dis. |volume=127 |issue=1 |pages=125–8 |date=January 1983 |pmid=6849536 |doi=10.1164/arrd.1983.127.1.125 |url=}}</ref>  
* Transient ventilatory support with noninvasive positive pressure ventilation (NPPV) or invasive [[mechanical ventilation]]:  it is used when patients with unilateral diaphragmatic paralysis develop acute respiratory dysfunction after general aneshesia or infections.   
* Transient ventilatory support with noninvasive positive pressure ventilation (NPPV) or invasive [[mechanical ventilation]]:  it is used when patients with unilateral diaphragmatic paralysis develop acute respiratory dysfunction after [[General anaesthesia|general anesthesia]] or [[infections]].   


==== Bilateral diaphragmatic paralysis ====
==== Bilateral diaphragmatic paralysis ====
Line 16: Line 16:
* Ventilatory support (invasive or noninvasive)
* Ventilatory support (invasive or noninvasive)
* Diaphragmatic pacing:  
* Diaphragmatic pacing:  
** It is done via stimilation of the diaphragm by implanted electrodes at the level of the neck or thorax. <ref name="pmid27195135">{{cite journal |vauthors=Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM |title=Diaphragm pacing: the state of the art |journal=J Thorac Dis |volume=8 |issue=Suppl 4 |pages=S376–86 |date=April 2016 |pmid=27195135 |pmc=4856845 |doi=10.21037/jtd.2016.03.97 |url=}}</ref>
** It is done via stimulation of the [[diaphragm]] by implanted [[electrodes]] at the level of the [[neck]] or [[thorax]]. <ref name="pmid27195135">{{cite journal |vauthors=Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM |title=Diaphragm pacing: the state of the art |journal=J Thorac Dis |volume=8 |issue=Suppl 4 |pages=S376–86 |date=April 2016 |pmid=27195135 |pmc=4856845 |doi=10.21037/jtd.2016.03.97 |url=}}</ref>
** It can not be done in patients with denervated diaphragams
** It can not be done in patients with denervated diaphragams.
** Best candidates for diaphragmatic pacing are patients with high level cervical cord injury.<ref name="pmid19067067">{{cite journal |vauthors=Onders RP, Elmo M, Khansarinia S, Bowman B, Yee J, Road J, Bass B, Dunkin B, Ingvarsson PE, Oddsdóttir M |title=Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients |journal=Surg Endosc |volume=23 |issue=7 |pages=1433–40 |date=July 2009 |pmid=19067067 |doi=10.1007/s00464-008-0223-3 |url=}}</ref>  
** Best candidates for diaphragmatic pacing are patients with high level [[Cervical Disc Disease|cervical cord injury]].<ref name="pmid19067067">{{cite journal |vauthors=Onders RP, Elmo M, Khansarinia S, Bowman B, Yee J, Road J, Bass B, Dunkin B, Ingvarsson PE, Oddsdóttir M |title=Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients |journal=Surg Endosc |volume=23 |issue=7 |pages=1433–40 |date=July 2009 |pmid=19067067 |doi=10.1007/s00464-008-0223-3 |url=}}</ref>  


===Diaphragmatic paralysis ===
===Diaphragmatic paralysis ===
Antiviral therapy for viral etiology of diaphragmatic paralysis:<ref name="pmid19277778">{{cite journal |vauthors=Crausman RS, Summerhill EM, McCool FD |title=Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm? |journal=Lung |volume=187 |issue=3 |pages=153–7 |date= 2009 |pmid=19277778 |doi=10.1007/s00408-009-9140-z |url=}}</ref>
[[Antiviral Therapy|Antiviral therapy]] for [[viral]] etiology of diaphragmatic paralysis:<ref name="pmid19277778">{{cite journal |vauthors=Crausman RS, Summerhill EM, McCool FD |title=Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm? |journal=Lung |volume=187 |issue=3 |pages=153–7 |date= 2009 |pmid=19277778 |doi=10.1007/s00408-009-9140-z |url=}}</ref>
* '''Adult'''
* '''Adult'''
** Valacyclovir 1000 mg twice daily for 1 week
** [[Valacyclovir]] 1000 mg twice daily for 1 week




Line 32: Line 32:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category: (name of the system)]]
 
[[Category:Medicine]]
[[Category:Pulmonology]]
[[Category:Up-To-Date]]

Latest revision as of 21:22, 29 July 2020

Diaphragmatic Paralysis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Diaphragmatic Paralysis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Guidelines for Management

Case Studies

Case #1

Diaphragmatic paralysis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Diaphragmatic paralysis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Diaphragmatic paralysis medical therapy

CDC on Diaphragmatic paralysis medical therapy

Diaphragmatic paralysis medical therapy in the news

Blogs on Diaphragmatic paralysis medical therapy

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Diaphragmatic paralysis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2] [3] [4] [5] [6]

Overview

No treatment is required for unilateral diaphragmatic paralysis because most patients are asymptomatic. In bilateral diaphragmatic paralysis treatment options are ventilatory support and diaphragmatic pacing.

Medical Therapy

Unilateral diaphragmatic paralysis

  • No treatment are required in unilateral diaphragmatic paralysis because most patients are asymptomatic.[1]
  • Transient ventilatory support with noninvasive positive pressure ventilation (NPPV) or invasive mechanical ventilation: it is used when patients with unilateral diaphragmatic paralysis develop acute respiratory dysfunction after general anesthesia or infections.

Bilateral diaphragmatic paralysis

  • Treatment options depends upon the severity of paralysis of the diaphragm and etiology. [2][3]
  • Ventilatory support (invasive or noninvasive)
  • Diaphragmatic pacing:

Diaphragmatic paralysis

Antiviral therapy for viral etiology of diaphragmatic paralysis:[6]


References

  1. Easton PA, Fleetham JA, de la Rocha A, Anthonisen NR (January 1983). "Respiratory function after paralysis of the right hemidiaphragm". Am. Rev. Respir. Dis. 127 (1): 125–8. doi:10.1164/arrd.1983.127.1.125. PMID 6849536.
  2. Davis J, Goldman M, Loh L, Casson M (January 1976). "Diaphragm function and alveolar hypoventilation". Q. J. Med. 45 (177): 87–100. PMID 1062815.
  3. Gibson GJ (November 1989). "Diaphragmatic paresis: pathophysiology, clinical features, and investigation". Thorax. 44 (11): 960–70. PMC 462156. PMID 2688182.
  4. Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM (April 2016). "Diaphragm pacing: the state of the art". J Thorac Dis. 8 (Suppl 4): S376–86. doi:10.21037/jtd.2016.03.97. PMC 4856845. PMID 27195135.
  5. Onders RP, Elmo M, Khansarinia S, Bowman B, Yee J, Road J, Bass B, Dunkin B, Ingvarsson PE, Oddsdóttir M (July 2009). "Complete worldwide operative experience in laparoscopic diaphragm pacing: results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients". Surg Endosc. 23 (7): 1433–40. doi:10.1007/s00464-008-0223-3. PMID 19067067.
  6. Crausman RS, Summerhill EM, McCool FD (2009). "Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm?". Lung. 187 (3): 153–7. doi:10.1007/s00408-009-9140-z. PMID 19277778.

Template:WH Template:WS