Table of Contents
Journal of Respiratory Medicine
Volume 2014 (2014), Article ID 683852, 6 pages
http://dx.doi.org/10.1155/2014/683852
Research Article

Explorations of Unilateral Diaphragmatic Paralysis

1Physiology Department, Rouen University Hospital, Rouen, France
2CRMPR-HN les herbiers, 76 420 Bois Guillaume, France
3Cervicofacial Surgery Department, Rouen University Hospital, Rouen, France
4Research Group on Ventilatory Handicap, GRHV, EA 3830, Rouen University, France

Received 19 May 2013; Revised 2 February 2014; Accepted 10 February 2014; Published 1 April 2014

Academic Editor: Norman R. Morris

Copyright © 2014 Alexandre Quesnel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective. The aim of the present study was to evaluate sniff test, maximal inspiratory pressure, and presence of paradoxical inspiratory diaphragmatic movements and their diagnostic value in patients referred for suspicion of diaphragmatic dysfunction. Methods. Twenty-two patients (8 men and 14 women, years) with suspected diaphragmatic dysfunction were included. Pulmonary function test was evaluated by spirometry. Diaphragm dysfunction was diagnosed with unilateral phrenic nerve stimulation. Esophageal pressure was recorded during sniff test and maximal static inspiratory movements. Detection of paradoxical diaphragmatic movement was performed with anteroposterior projection of chest X-ray fluoroscopic video. Results. Phrenic nerve stimulation enabled diagnosis of diaphragmatic paralysis in 15 of the 22 patients. The remaining 7 patients had normal explorations. Lung volumes were significantly lower in patients with diaphragmatic paralysis than in control subjects, as maximal inspiratory pressure. No patient with normal diaphragmatic exploration had paradoxical inspiratory movement. The combined diagnostic value of reduced esophageal pressure during sniff test, reduced esophageal pressure during maximal static inspiratory movements, and presence of paradoxical inspiratory movement had a sensitivity of 87% and a specificity of 71%. Conclusion. Our results suggest that, in most cases, a combination of sniff test, maximal inspiratory pressure, and paradoxical inspiratory movement could help to diagnose diaphragmatic dysfunction. Nevertheless, phrenic nerve stimulation remains the best test for assessing diaphragmatic dysfunction.