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European Archives of Oto-Rhino-Laryngology

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01-05-2018 | Head and Neck

Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection

Authors: Anne Flavia Silva Galindo Santana, Pedro Caruso, Pauliane Vieira Santana, Gislaine Cristina Lopes Machado Porto, Luiz Paulo Kowalski, Jose Guilherme Vartanian

Published in: European Archives of Oto-Rhino-Laryngology | Issue 5/2018

Abstract

Background

Inspiratory strength after a neck dissection has not been evaluated, and diaphragm function has not been adequately evaluated.

Objective

Evaluate diaphragm mobility and inspiratory strength after neck dissection.

Methods

Prospective data collection of a consecutive series of adult patients submitted to neck dissection for head and neck cancer treatment, in a tertiary referral cancer center, from January to September 2014, with 30 days of follow-up. A total of 43 were studied (recruited 56; excluded 13).

Main outcome measures

Determine diaphragm mobility and inspiratory muscle strength after neck dissection, using diaphragm ultrasound and by measuring maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP).

Results

Thirty patients underwent unilateral neck dissection, and thirteen patients underwent bilateral neck dissection. Diaphragm immobility occurred in 8.9% of diaphragms at risk. For the entire cohort, inspiratory strength decreased immediately after the dissection but returned to preoperative values after 1 month. Except for those with diaphragm immobility, diaphragm mobility remained unchanged after the dissection. One month after the dissection, the diaphragm thickness decreased, indicating diaphragm atrophy.

Conclusions

Immediately after a neck dissection, just a few patients showed diaphragmatic immobility, and there was a transient decrease in inspiratory strength in all individuals. Such findings can increase the risk of postoperative complications in patients with previous lung disease.

Ferlito A, Robbins KT, Shah JP, Medina JE, Silver CE, Al-Tamimi S et al (2011) Proposal for a rational classification of neck dissections. Head Neck 33:445–450PubMed

Vartanian JG, Pontes E, Agra IM, Campos OD, Goncalves-Filho J, Carvalho AL et al. (2003) Distribution of metastatic lymph nodes in oropharyngeal carcinoma and its implications for the elective treatment of the neck. Arch Otolaryngol Head Neck Surg 129:729–732CrossRefPubMed

Laghi F, Tobin MJ (2003) Disorders of the respiratory muscles. Am J Respir Crit Care Med 168:10–48CrossRefPubMed

McCool FD, Tzelepis GE (2012) Dysfunction of the diaphragm. N Engl J Med 366:932–942CrossRefPubMed

Rochester DF, Farkas GA (1995) Performance of respiratory muscles in situ. In: Roussos C (ed) The thorax: applied physiology. Marcel Dekker, New York. 1127–1159

Siafakas NM, Mitrouska I, Bouros D, Georgopoulos D (1999) Surgery and the respiratory muscles. Thorax 54:458–465CrossRefPubMedPubMedCentral

Bergman NA, Tien YK (1983) Contribution of the closure of pulmonary units to impaired oxygenation during anesthesia. Anesthesiology 59:395–401CrossRefPubMed

Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB (2011) Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med 39:2163–2172CrossRefPubMed

de Jong AA, Manni JJ (1991) Phrenic nerve paralysis following neck dissection. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino. Laryngol Soc 248:132–134

10.

Moorthy SS, Gibbs PS, Losasso AM, Lingeman RE (1983) Transient paralysis of the diaphragm following radical neck surgery. Laryngoscope 93:642–644CrossRefPubMed

11.

Yaddanapudi S, Shah SC (1996) Bilateral phrenic nerve injury after neck dissection: an uncommon cause of respiratory failure. J Laryngol Otol 110:281–283PubMed

12.

Gottesman E, McCool FD (1997) Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 155:1570–1574CrossRefPubMed

13.

Boon AJ, Harper CJ, Ghahfarokhi LS, Strommen JA, Watson JC, Sorenson EJ (2013) Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve 47:884–889CrossRefPubMed

14.

Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N (2011) Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol 37:44–52CrossRefPubMed

15.

Piccirillo JF, Feinstein AR (1996) Clinical symptoms and comorbidity: significance for the prognostic classification of cancer. Cancer 77:834–842CrossRefPubMed

16.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET et al. (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefPubMed

17.

American Thoracic Society/European Respiratory S. (2002) ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 166:518–624CrossRef

18.

Steier J, Kaul S, Seymour J, Jolley C, Rafferty G, Man W et al (2007) The value of multiple tests of respiratory muscle strength. Thorax 62:975–80CrossRefPubMedPubMedCentral

19.

Boussuges A, Gole Y, Blanc P (2009) Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 135:391–400CrossRefPubMed

20.

Cohn D, Benditt JO, Eveloff S, McCool FD (1997) Diaphragm thickening during inspiration. J Appl Physiol 83:291–296CrossRefPubMed

21.

Ueki J, De Bruin PF, Pride NB (1995) In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax 50:1157–1161CrossRefPubMedPubMedCentral

22.

Lerolle N, Guerot E, Dimassi S, Zegdi R, Faisy C, Fagon JY et al (2009) Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 135:401–407CrossRefPubMed

23.

Kim SH, Na S, Choi JS, Na SH, Shin S, Koh SO (2010) An evaluation of diaphragmatic movement by M-mode sonography as a predictor of pulmonary dysfunction after upper abdominal surgery. Anesthesia Analgesia 110:1349–1354CrossRefPubMed

24.

Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F et al (2013) Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 39:801–10CrossRefPubMed

25.

Iverson LI, Mittal A, Dugan DJ, Samson PC (1976) Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma. Am J Surg 132:263–269CrossRefPubMed

26.

Rosett RL (1987) An unusual cause of postoperative respiratory failure. Anesthesiology 66:695–697CrossRefPubMed

27.

Goligher EC, Laghi F, Detsky ME, Farias P, Murray A, Brace D et al (2015) Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med 41:734CrossRefPubMed

28.

Baldwin CE, Paratz JD, Bersten AD (2011) Diaphragm and peripheral muscle thickness on ultrasound: intra-rater reliability and variability of a methodology using non-standard recumbent positions. Respirology 16:1136–1143CrossRefPubMed

29.

Sarwal A, Parry SM, Berry MJ, Hsu FC, Lewis MT, Justus NW et al. (2015) Interobserver reliability of quantitative muscle sonographic analysis in the critically ill population. J Ultrasound Med Off J Am Instit Ultrasound In Med 34:1191–200

30.

Nava S, Ambrosino N, Crotti P, Fracchia C, Rampulla C (1993) Recruitment of some respiratory muscles during three maximal inspiratory manoeuvres. Thorax 48:702–707CrossRefPubMedPubMedCentral

31.

Verin E, Delafosse C, Straus C, Morelot-Panzini C, Avdeev S, Derenne JP et al (2001) Effects of muscle group recruitment on sniff transdiaphragmatic pressure and its components. Eur J Appl Physiol 85:593–598CrossRefPubMed

32.

Vassilakopoulos T, Mastora Z, Katsaounou P, Doukas G, Klimopoulos S, Roussos C et al (2000) Contribution of pain to inspiratory muscle dysfunction after upper abdominal surgery: a randomized controlled trial. American J Respir Crit Care Med 161:1372–1375CrossRef

33.

Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D et al (2015) Evolution of diaphragm thickness during mechanical ventilation: impact of inspiratory effort. Am J Respir Crit Care Med 192(9):1080–1088CrossRefPubMed

34.

Evans WJ (2010) Skeletal muscle loss: cachexia, sarcopenia, and inactivity. Am J Clin Nutr 91:1123S–1127SCrossRefPubMed

35.

Laroche CM, Carroll N, Moxham J, Green M (1988) Clinical significance of severe isolated diaphragm weakness. Am Rev Respir Dis 138:862–866CrossRefPubMed

36.

Teitelbaum J, Borel CO, Magder S, Traystman RJ, Hussain SN (1993) Effect of selective diaphragmatic paralysis on the inspiratory motor drive. J Appl Physiol 74:2261–2268CrossRefPubMed

Title: Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection
Authors: Anne Flavia Silva Galindo Santana
Pedro Caruso
Pauliane Vieira Santana
Gislaine Cristina Lopes Machado Porto
Luiz Paulo Kowalski
Jose Guilherme Vartanian
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 5/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-018-4923-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection

Abstract

Background

Objective

Methods

Main outcome measures

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Main outcome measures

Results

Conclusions

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