Nerve injury generally results in transient paralysis (although in a small percentage of patients, the condition is permanent), with an elevation of one side, generating limited respiratory muscle movement. Phrenic nerve injury can also occur as a consequence of ablation due to atrial fibrillation. During cardiac surgery involving sternotomy, a phrenic nerve injury may occur for various reasons including: hypothermia, the effects of sternal retractors (mechanical trauma), decreased vascular supply to the phrenic nerve from the internal mammary artery (ischemia), abnormal position of the phrenic nerve behind the pericardium, and previous presence of adherence in the phrenic nerve path (elongated). Specifically, we describe a cardiac surgery patient suffering from chronic obstructive pulmonary disease and a patient with a left ventricular assist device (L-VAD). This article describes how to use the Manual Evaluation Diaphragm (MED) scale, using two examples of clinical evaluations conducted in our cardio-respiratory department.
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