Abstract

Background:Diaphragmatic paralysis may occur as a result of dysfunction in the central nervous system or phrenic nerves leading to inspiratory muscle weakness and a restrictive ventilatory deficit. Phrenic nerve reconstruction and diaphragm pacemakers have each been studied independently as effective therapeutic modalities. Methods:We report three cases of diaphragmatic paralysis in patients with particularly complex pathological processes to investigate the use of multi-modality therapy consisting of phrenic nerve reconstruction and diaphragm pacemakers. Results:The primary etiology of the diaphragmatic paralysis in all three patients was an iatrogenic injury. Two patients had underlying systemic disease complicating the phrenic nerve injury-central hypoventilation syndrome in one patient, and another patient with diabetic peripheral neuropathy. All patients reported significant improvement in respiratory activity and physical functioning after treatment. Conclusion:The occurrence of diaphragmatic paralysis in patients with complex or recalcitrant neuromuscular pathology may be successfully reversed after phrenic nerve reconstruction and implantation of diaphragm pacemakers.

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