DIAPHRAGMATIC PARESIS AND RESPIRATORY INS UFFICIENCY

Background: Phrenic nerve palsy leads to disfunction of the main respi ratory muscle. With bilateral palsy dyspnoea in the supine body positi on will typically occur. With one-sided lesion symptoms will only appe ar when a second pulmonary disease is present. Patients: We refer of 6 patients with bilateral and 5 with unilateral diaphragmatic paresis. In 3 patients neuralgic shoulder-arm-amyotrophy was diagnosed, in furt her 4 there was suspicion of it. Amyotrophic lateral sclerosis develop ed in 2 after 4 respectively 8 months. In 1 case a cervical operation led to palsy, mediascinitis in 1 case. Lung function tests showed a re strictive pattern, especially in bilateral palsy. Results: Vital capac ity was reduced by almost 50% respectively 25% in the supine body posi tion. Mouth occlusion pressure reduction was apparent. Near normal to marked hyperkapnia developed in bilateral paresis. In 5 cases non-inva sive intermittent ventilation is instituted (2 volume controlled, 3 pr essure supported). Two patients died (1 patient with amyotrophic later al sclerosis after 13 months, 1 with malignant pleurisy after 4 months ). Three patients continued non-invasive intermittent ventilation sinc e 14 to 64 months.