Key Clinical Message: Forced inspiration during mechanical ventilation risks self-inflicted lung injury. However, controlling it with sedation or paralysis may cause polyneuropathy and myopathy. We tested bilateral phrenic nerve paralysis with local anesthetic in a patient, showing reduced inspiratory force. This offers an alternative to drug-induced muscle paralysis.
Abstract: Mechanical ventilation, although a life-saving measure, can also pose a risk of causing lung injury known as "ventilator-induced lung injury" or VILI. Patients undergoing mechanical ventilation sometimes exhibit heightened inspiratory efforts, wherein the negative pressure generated by the respiratory muscles adds to the positive pressure generated by the ventilator. This combination of high pressures can lead to a syndrome similar to VILI, referred to as "patient self-inflicted lung injury" or P-SILI. Prevention of P-SILI requires the administration of deep sedation and muscle paralysis to the patients, but both these measures can have undesired effects on their health. In this case report, we demonstrate the effect of a bilateral phrenic nerve block aiming to reduce excessive inspiratory respiratory efforts in a patient suffering from COVID-19 pneumonitis.
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http://dx.doi.org/10.1002/ccr3.8850 | DOI Listing |
J Med Ultrasound
November 2024
Department of Anesthesiology, Ibra Hospital, Ibra, Oman.
Background: It is very well known that the supraclavicular nerve (SCN) which occupies the inferior part of the superficial cervical plexus basically originates from the ventral rami of C2-C4, then travels caudally into the investing layer of the deep cervical fascia (IL-DCF) alternatively termed the "prevertebral fascia."
Methods: This cadaveric study (a total of 6 soft-embalmed cadavers and bilateral dissections, i.e.
Ann Thorac Surg Short Rep
September 2024
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Dynamic chest radiography (DCR) is a novel radiographic technique that evaluates the thoracic movement from inspiration to expiration. Here, we report the efficacy of DCR in the surgical treatment of diaphragmatic paralysis. A 60-year-old woman presented with phrenic nerve palsy after anterior mediastinal resection.
View Article and Find Full Text PDFCureus
October 2024
Physical Medicine and Rehabilitation, Unidade Local de Saúde de Coimbra, Coimbra, PRT.
Curr Opin Crit Care
February 2025
Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
BMJ Open
November 2024
Department of Rehabilitation Medicine, Fujian Medical University Affiliated Fuzhou First Hospital, Fuzhou, Fujian, China
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