Monitoring postoperative diaphragm function by transdiaphragmatic central venous pressure measurement, a clinical study.

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  • Nogimura Hiroshi
    First Department of Surgery, Hamamatsu University School of Medicine
  • Toyoda Futoru
    First Department of Surgery, Hamamatsu University School of Medicine
  • Kobayashi Ryou
    First Department of Surgery, Hamamatsu University School of Medicine
  • Horiguchi Tomohiro
    First Department of Surgery, Hamamatsu University School of Medicine
  • Suzuki Kazuya
    First Department of Surgery, Hamamatsu University School of Medicine
  • Harada Yukio
    First Department of Surgery, Hamamatsu University School of Medicine

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  • 経横隔膜中心静脈圧による術後横隔膜機能モニターの臨床的試み

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Abstract

Diaphragm dysfunction in one of the postoperative complications after thracotomy and upperlaparotomy.<BR>The measurement of transdiaphragmatic pressure by the esophago-gastric balloon technique is a method of evaluating diaphragm function, but its use in continuous measurements in postoperative patients is difficult. On the other hand, a central venous catheter has been inserted in most postoperative patients. Provided that transdiaphragmatic pressure can be deduced from transdiaphragmatic central venous pressure, it can be used as a diaphragm function monitor in postoperative patients.<BR>Our animal experiments showed correlations between respiratory changes in transdiaphragmatic gastrointestinal pressure and transdiaphragmatic central venous pressure. In the pressent study, we measured transdiaphragmatic central venous pressure in clinical cases and evaluated its usefulness in determining diaphragm function.<BR>In patients undergoing standerd lobectomy, the superior vena cava mean pressure (PSVC) and inferior vena cava mean pressure (PIVC) were measured and pressure changes during respiration (ΔP) were recorded. Changes in the transdiaphragmatic central venous pressure (ΔPDI =ΔPIVC-ΔPSVC) and the ratio of ΔPIVC/ΔPDI were calculated. The pressures were measuredbefore, 24 hrs and 48 hrs after thoracotomy, at rest and during maximum forced respiration.<BR>There were no significant changes in ΔPDI either at rest or during maximum forced respiration. ΔPIVC/ΔPDI decreased significantly 24 hrs and 48 hrs after thoracotomy either at rest or during maximum forced respiration.<BR>The results suggest that the measurement of transdiaphragmatic central venous pressure can be employed clinically as a parameter for continuous monitoring of postoperative diaphragm function.

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