• Driss Laghlam, Minh Pierre Lê, Alexandre Srour, Raphael Monsonego, Philippe Estagnasié, Alain Brusset, and Pierre Squara.
• Department of Cardiology and Critical Care, Clinique Ambroise Paré, Neuilly-sur-Seine, France. Electronic address: driss.laghlam@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2021 Nov 1; 35 (11): 3241-3247.

ObjectivesThe aim of this study was to re-investigate the incidence, risk factors, and outcomes of postoperative diaphragmatic dysfunction (DD) with actual cardiac surgery procedures.DesignSingle-center, retrospective, observational study based on a prospectively collected database.SettingTertiary care cardiac surgery center.ParticipantsPatients who underwent cardiac surgery between January 2016 and September 2019.InterventionsNone.Measurements And Main ResultsThe DD group included patients with clinically perceptible diaphragmatic paralysis, which was confirmed by chest ultrasound (amplitude of the diaphragm movement in time-motion mode at rest, after a sniff test). The primary endpoint was the incidence of DD. Among 3,577 patients included, the authors found 272 cases of DD (7.6%). Individuals with DD had more arterial hypertension (64.3% v 52.6%; p < 0.0001), higher body mass index (BMI) (28 [25-30] kg/m2v 26 [24-29] kg/m2; p < 0.0002), and higher incidence of coronary bypass grafting (CABG) (58.8% v 46.6%; p = 0.0001). DD was associated with more postoperative pneumonia (23.9% v 8.7%; p < 0.0001), reintubation (8.8% v 2.9%; p < 0.0001), tracheotomy (3.3% v 0.3%; p < 0.0001), noninvasive ventilation (45.6% v 5.4%; p < 0.0001), duration of mechanical ventilation (five [four-11] hours v four [three-six] hours; p < 0.0001), and intensive care unit and hospital stays (14 [11-17] days v 13 [11-16] days; p < 0.0001). In multivariate analysis, DD was associated with CABG (odds ratio [OR] 1.9 [1.5-2.6]; p = 0.0001), arterial hypertension (OR 1.4 [1.1-1.9]; p = 0.008), and BMI (OR per point 1.04 [1.01-1.07] kg/m2; p = 0.003).ConclusionsThe incidence of symptomatic DD after cardiac surgery was 7.6%, leading to respiratory complications and increased ICU stay. CABG was the principal factor associated with DD.Copyright © 2021 Elsevier Inc. All rights reserved.

15 keywords...

hide…