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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a prospective study, 100 patients undergoing open heart surgery were randomly allocated to receive ice/slush topical hypothermia for myocardial protection (Group I, n = 56) or not (Group II, n = 44). Chest radiographs, diaphragm screening, lung function and phrenic nerve conduction time were assessed pre-operatively and at 1 week and 1 month post-operatively in all patients and subsequently at 3 months, 6 months, 1 year and 2 years in all patients with radiological evidence of diaphragm paralysis. The two groups were similar in terms of age, sex, diabetes and smoking habits. Cardiopulmonary bypass and aortic cross-clamp times were similar in the two groups. Radiological evidence of partial left lower lobe collapse was more frequent in Group I (79 per cent vs. 36 per cent, p < 0.01). Twenty (36 per cent) Group I patients developed unilateral diaphragm paralysis (19 left-sided) compared with none in Group II. Diaphragm paralysis was still present in 19 patients (34 per cent) at 1 month, in five patients (9 per cent) at 1 year and in one patient (2 per cent) at 2 years post-operatively. Phrenic nerve conduction time was recorded in 98 per cent of patients pre-operatively, but was unrecordable on the appropriate side in all 20 patients with diaphragm paralysis 1 week post-operatively. Prolonged phrenic nerve conduction time on the left side was found in a further seven Group I patients 1 week post-operatively. There were no significant differences between the two groups in terms of post-operative arrhythmias, myocardial infarction or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Phrenic nerve and diaphragm function following open heart surgery: a prospective study with and without topical hypothermia. 148 46

Diaphragm paralysis has been reported radiologically after cardiac surgery with an incidence ranging from 30% to 75% of patients. We studied 100 consecutive patients undergoing open heart operations, half of whom received ice/slush topical hypothermia (group 1) and half of whom did not (group 2). Chest radiology and diaphragm screening were performed at 1 week, 1 month, and every 6 months thereafter in all patients with an elevated diaphragm. Phrenic nerve conduction time was measured in all patients in whom there was radiological evidence of diaphragm paralysis 1 week postoperatively. The two groups were similar in terms of age and sex. Aortic cross-clamp time was less in group 1 (61.5 +/- 15.6 minutes) compared with group II (74.4 +/- 20.8 minutes), although this difference was not significant. Significant differences, however, were found for radiological evidence of partial left lower lobe collapse (82% in group 1 versus 32% in group 2; p less than 0.01) and for radiological evidence of diaphragm paralysis (32% in group 1 versus 2% in group 2; p less than 0.001) within the first postoperative week. Unilateral diaphragm paralysis developed in 16 group 1 patients (15 left sided, 1 right sided) compared with only 1 patient in group 2. In these 16 group 1 patients, diaphragm paralysis was still present in 12 (75%) at 1 month and in 5 (31.3%) at 1 year postoperatively. There were no significant differences between the two groups in terms of postoperative arrhythmias, myocardial infarction, or mortality. Phrenic nerve conduction time was found to be a sensitive indicator of phrenic nerve cold injury and recovery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diaphragm paralysis following cardiac surgery: role of phrenic nerve cold injury. 192 16

Phrenic nerve injury was evaluated prospectively in 133 patients undergoing open-heart surgery using iced saline slush for topical hypothermia. In the control group of 70 patients no attempt was made to shield the phrenic nerves from direct exposure to ice. Phrenic nerve damage occurred in 73% of these patients, as assessed by persistent diaphragm paralysis evident on inspiratory chest roentgenogram. In 2 patients the paralysis was bilateral. In the second group of 63 patients a pericardial insulation pad was used to prevent contact of the iced slush to the phrenic nerve. Diaphragm paralysis was observed in 17% of these patients. This difference was highly significant (p less than .001). Diaphragm paralysis in the control group was clinically significant; life-threatening respiratory complications developed in 7 patients (14%), frequently resulting in multiple reintubations, tracheostomy, and prolonged mechanical ventilation. In addition, 4 patients with phrenic nerve injury exhibited a clinical syndrome consistent with gastric ileus, which may possibly represent hypothermic injury to the thoracic vagi. The likelihood of phrenic nerve injury when iced saline slush is used for topical myocardial cooling and the possibility of developing serious respiratory disability would support the routine use of pericardial insulation when this method of hypothermia is used.
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PMID:The effect of pericardial insulation on hypothermic phrenic nerve injury during open-heart surgery. 382 75