Liet et al described making the bedside diagnosis of bilateral diaphragmatic paralysis. This can be a difficult diagnosis unless suspected clinically. The authors are from Hopital Mere-Enfant in Nantes, France.
Clinical presentation:
(1) unexplained respiratory distress
(2) spontaneous breathing activity is present
Clues to diagnosis:
(1) the absence of asymmetry in movement of the diaphragm during respiration on fluoroscopy
(2) reduction in lung volumes on pulmonary function testing
(3) abnormal maximum inspiratory pressure in cm H2O
(4) recognition of a cause for diaphragmatic paralysis in the patient
The diagnosis can be made with an esophageal probe connected to a ventilator (Bordessoule et al). The probe detects electrical activity of the diaphragm in microVolts. The absence of electrical activity in the diaphragm favors the diagnosis.
To read more or access our algorithms and calculators, please log in or register.
