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Phrenic Nerve Damage

The phrenic nerve controls the diaphragm and breathing. It runs from the brain down the spine to each side of the diaphragm. Damage can occur from spinal cord injuries, neck trauma, or complications during heart or abdominal surgery near the phrenic nerve. Symptoms of phrenic nerve damage include difficulty breathing with exertion. Diagnosis involves tests like chest x-rays and pulmonary function tests. For some patients, a diaphragm pacing device can help treat phrenic nerve damage by stimulating the nerve and causing the diaphragm to contract.

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Izza Mae Ferrancol Pastrana
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916 views15 pages

Phrenic Nerve Damage

The phrenic nerve controls the diaphragm and breathing. It runs from the brain down the spine to each side of the diaphragm. Damage can occur from spinal cord injuries, neck trauma, or complications during heart or abdominal surgery near the phrenic nerve. Symptoms of phrenic nerve damage include difficulty breathing with exertion. Diagnosis involves tests like chest x-rays and pulmonary function tests. For some patients, a diaphragm pacing device can help treat phrenic nerve damage by stimulating the nerve and causing the diaphragm to contract.

Uploaded by

Izza Mae Ferrancol Pastrana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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PHRENIC

NERVE
DAMAGE

WHAT IS PHRENIC NERVE?


The phrenic nerve is actually a twin nerve, with one
on the left side and one on the right of the
diaphragm. The nerves serve to send signals between
the brain and the diaphragm. The phrenic nerve is
responsible for handling decisions in the ability to
hold your breath or to take a deep breath. When the
nerve is damaged, this control is lost.

W H E R E I S P H R E N I C N E RV E ?
The phrenic nerve begins in the brain and then continues down to the
first few vertebrae of the spine, where it then splits. The two nerves then
continue through each side of the body, with the right side coming in
contact with the windpipe and heart, while passing the lungs. The left
side also comes in close contact with the heart, with both sides
eventually ending up in the diaphragm. Because of its location and
proximity to both the lungs and the heart, the nerve can be impacted if
there are specific conditions in either of these organs. If either of the
nerves is damaged and signals between the brain and diaphragm are
interrupted, normal breathing may be prevented.

C A U S E S O F P H R E N I C N E RV E
DAMAGE
Spinal cord injury: Depending on which vertebrae are damaged, nerve
impulses can be disrupted. It is more likely if the injury occurs above
the third vertebrae. If the injury is lower in the spine, breathing is
usually not impacted.
Physical trauma
- Neck injury, as related to above
Surgical complications or trauma
- Up to 10% of cases of phrenic nerve damage are caused by
operative trauma
- Because of its location, damage can unintentionally occur during
heart or abdominal surgery.

SIGNS AND
SYMPTOMS
Exertion dyspnea
Poor exercise tolerance
Chest pain
Cough
Hiccups
asymptomatic

DIAGNOSIS
Chest x-ray or sniff test
PFT
CT Scan
Chest radiograph

Sniff test paradoxical upward motion of


affecetd side
Normal excursion of 1-2 ribs:
breath in, diaphragm down.
Breath out, diaghragm up.
Paralyzed paradoxical motion:
Breath in, diaphragm up.
Breath out, diaphragm down.

COMPLICATION
Diaphragmatic dysfunction following cardiac surgery
- Phrenic nerve injury commonly occurs from cold
cardioplegia or mechanical stretching during open-heart
surgery.
- Diaphragmatic dysfunction often occurs postoperatively
in patients undergoing cardiac surgery. This has been
attributed to pleurotomy in order to harvest internal
mammary artery (IMA) grafts, which results in greater chest
wall and parenchymal trauma, greater pain, and impairment
of cough and deep breathing. In addition, IMA dissection
may reduce blood supply to ipsilateral intercostal muscles
and may cause mechanical injury to the phrenic nerve.

MANAGEMENT
Those who are eligible may utilize the Avery
Breathing Pacemaker System, the only diaphragm
pacing system with full pre-market approval from
the USFDA and CE marking privileges under the
European Active Implantable Medical Device
Directive for both adult and pediatric use. It is
available for patients with an intact phrenic nerve.
The pacemaker may be used for patients with
phrenic nerve damage from the above causes, as
well as those suffering from CCHS, ALS, and
diaphragm paralysis.

The pacemaker works by stimulating the phrenic nerve.


The stimulator is surgically implanted with the surgeon
placing an electrode next to the phrenic nerve. Patients can
receive one or two implants, depending on whether one or
both nerves are damaged. Next, the surgeon implants a
receiver just under the skin. The receivers convert the
radio waves into stimulating pulses that are sent down the
electrodes to the phrenic nerves, causing the diaphragm to
contract. The surgery itself is typically performed in less
than four hours, and the patient is usually discharged after
one or two days. Depending on the patients presenting
symptoms and medical history, it can sometimes be
performed in an outpatient setting.

THANK YOU

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