Phrenic Nerve Injury

Excerpt

The phrenic nerve is among the most important nerves in the body due to its role in respiration. The phrenic nerve provides the primary motor supply to the diaphragm, the major respiratory muscle. Phrenic nerve injury, such as may occur from cardiothoracic surgery, can lead to diaphragmatic paralysis or dysfunction. The presentation of phrenic nerve injury is non-specific, and the diagnosis may easily be missed. Phrenic nerve injury can be identified by a number of imaging modalities including ultrasound, electromyography, and fluoroscopy.

Ultrasound is ideal and emerging as a diagnostic test for this condition as the modality is non-invasive, poses no risk of ionizing radiation, is easily reproducible, low cost and may be performed at the bedside. This is especially ideal for critical patients. Ultrasound is more commonly being used to evaluate phrenic nerve injury due to its ability to evaluate the function and structure of the diaphragm. Ultrasound of the diaphragm can help clinicians identify diseases caused by phrenic nerve injury including diaphragmatic paralysis and diaphragmatic dysfunction. Ultrasound can sometimes identify the etiology behind the disease and provide data for determining prognosis. Diaphragmatic ultrasound is also useful in the assessment of prolonged mechanical ventilation and assessment of the failure of weaning from mechanical ventilation. This modality can additionally help select patients for early surgical plication (which can decrease intensive care unit length of stay and ventilator-associated pneumonia).