Continuous positive airway pressure in hemidiaphragmatic paralysis

Abstract

Infants and children with unilateral phrenic-nerve injury in respiratory distress are often able to maintain adequate ventilation while breathing spontaneously with continuous positive airway pressure (CPAP). The most common causes of phrenic injuries in children are brachial plexus injuries incurred at birth and iatrogenic injuries incurred with retraction of the pericardium during cardiac surgical procedures. Unilateral diaphragmatic paralysis in adults impairs ventilatory function but usually does not lead to significant embarrassment. In infants and children, severe respiratory compromise can result. The opportunity to study a 6-month-old child with chronic respiratory distress due to unilateral diaphragmatic paralysis has allowed the authors to examine the pathophysiology of this problem and the therapeutic role of CPAP.