Document Detail


A prospective study of phrenic nerve damage after cardiac surgery in children.
MedLine Citation:
PMID:  18176797     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To gather detailed data on the incidence of phrenic nerve damage (PND) following cardiac surgery in children, the risk factors for its development, its effect on morbidity and its prognosis. DESIGN: Prospective electrophysiological measurement of phrenic nerve latency in 310 children before and after cardiac surgery. SETTING: Tertiary paediatric cardiac surgical centre. MEASUREMENTS AND RESULTS: Our findings were fourfold. Firstly, the incidence of PND in our group of patients was 20%, significantly higher than estimates using indirect methods of assessment. Secondly, PND increased the duration of ventilation by a median of 76 h (20 vs. 96 h; p<0.001), and late post-operative deaths (before hospital discharge) occurred in 12.9% of patients compared to 2.4% among patients with a normal post-operative phrenic latency. Thirdly, the risk factors that were independently predictive of the development of PND were the site of the surgery and the patient's age. Patients who required surgery at both the lung hilum and the pericardium were more likely to develop PND than patients with only one of those sites, or when neither was involved, and children less than 18 months old were more likely to develop PND than older children. Lastly, the natural history of PND following surgery appears to be good. In our follow-up to 3 months, approximately one third recovered within 1 month and a further third (overall) recovered by 3 months. CONCLUSIONS: We conclude that the incidence of PND is much higher than currently recognised, and has a very significant effect on post-operative morbidity and mortality. Most children who survive the post-operative period will recover nerve function within 3 months.
Authors:
Robert I Ross Russell; Peter J Helms; Martin J Elliott
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Publication Detail:
Type:  Journal Article     Date:  2008-01-05
Journal Detail:
Title:  Intensive care medicine     Volume:  34     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-24     Completed Date:  2008-10-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  728-34     Citation Subset:  IM    
Affiliation:
Department of Paediatrics, Box 181, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, CB2 2QQ, Cambridge, UK. robert.ross-russell@addenbrookes.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures / adverse effects*,  mortality
Female
Great Britain / epidemiology
Humans
Incidence
Infant
Infant, Newborn
Logistic Models
Male
Peripheral Nervous System Diseases / epidemiology,  etiology
Phrenic Nerve / injuries*
Prognosis
Prospective Studies
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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