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A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis

Syeda Nafisa, Ben Messer, Beatrice Downie, Patience Ehilawa, William Kinnear, Sherif Algendy, Milind Sovani
ERJ Open Research 2021 7: 00953-2020; DOI: 10.1183/23120541.00953-2020
Syeda Nafisa
1Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
2Dept of Respiratory Medicine, Sherwood Forest Hospital NHS Foundation Trust, Mansfield, UK
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  • ORCID record for Syeda Nafisa
  • For correspondence: s.nafisa@nhs.net
Ben Messer
3North East Assisted Ventilation Service, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, UK
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Beatrice Downie
4Dept of Respiratory Medicine, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne, UK
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Patience Ehilawa
1Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
2Dept of Respiratory Medicine, Sherwood Forest Hospital NHS Foundation Trust, Mansfield, UK
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  • ORCID record for Patience Ehilawa
William Kinnear
5Dept of Sport Science, Nottingham Trent University, Nottingham, UK
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Sherif Algendy
2Dept of Respiratory Medicine, Sherwood Forest Hospital NHS Foundation Trust, Mansfield, UK
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Milind Sovani
1Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
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  • FIGURE 1
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    FIGURE 1

    Scatterplots of a) maximal expiratory pressure (MEP)/maximal inspiratory pressure (MIP) and b) MEP/sniff nasal inspiratory pressure (SNIP) against fall in seated to supine vital capacity (VC) at presentation in subjects with diaphragm paralysis (a) r2=0.76, b) r2=0.68; p<0.05). Receiver operating characteristic curves comparing the percentage postural fall in VC with c) MEP/MIP and d) MEP/SNIP.

Tables

  • Figures
  • TABLE 1

    Aetiology of diaphragm paralysis

    Patients n
    Idiopathic31
    Post-heart–lung transplant18
    Post-coronary artery bypass grafting2
    Post-radiofrequency cardiac ablation2
    Post-spinal surgery1
    Post-thyroidectomy1
    Post-mastectomy1
    Post-radiotherapy1
    Post-intensive care unit admission1
  • TABLE 2

    Symptoms and clinical signs in 60 patients with diaphragm paralysis at presentation

    Patients n
    Dyspnoea on exertion28
    Orthopnoea32
    Paradoxical abdominal motion10
    Difficulty in weaning from ventilation10
    Morning headaches9
    Daytime somnolence9
    Immersion dyspnoea3
    Post-operative nocturnal desaturation3
    Sleep disturbance3
  • TABLE 3

    Lung function at presentation and after 1 year of noninvasive ventilation (NIV)

    At presentationAfter 1 year of NIVp-value
    Seated VC (L)1.7±1.22.1±0.9<0.001
    Seated VC (% pred)49±0.1760±0.2<0.001
    Supine VC (L)1.1±0.91.8±1<0.001
    Fall in VC seated to supine (% seated)42±0.1629±0.17<0.001
    MEP (cmH20)103±8132±70.14
    MEP (% pred)84±496±60.19
    MIP (cmH20)34±1050±80.27
    MIP (% pred)32±563±50.31
    SNIP (cmH20)29±547.5±7<0.001
    SNIP (% pred)28±342±2<0.001
    MEP/MIP ratio3±1.22.6±1.4<0.001
    MEP/SNIP ratio3.5±1.92.9±1.7<0.001

    Data are presented as mean±sd, unless otherwise stated. VC: vital capacity; MEP: maximal expiratory pressure; MIP: maximal inspiratory pressure; SNIP: sniff nasal inspiratory pressure.

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    A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis
    Syeda Nafisa, Ben Messer, Beatrice Downie, Patience Ehilawa, William Kinnear, Sherif Algendy, Milind Sovani
    ERJ Open Research Jul 2021, 7 (3) 00953-2020; DOI: 10.1183/23120541.00953-2020

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    A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis
    Syeda Nafisa, Ben Messer, Beatrice Downie, Patience Ehilawa, William Kinnear, Sherif Algendy, Milind Sovani
    ERJ Open Research Jul 2021, 7 (3) 00953-2020; DOI: 10.1183/23120541.00953-2020
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