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• W2020136241 abstract "To the Editor: Doctors Abd and Braun bring up some interesting points in their comments about phrenic nerve injury. We wish to emphasize, however, that the primary goal of our study was to prospectively evaluate the effect of one change in surgical technique on an important complication associated with open heart surgery. Because we looked at postoperative alterations in chest radiographic findings and pulmonary function, we felt that these changes were directly attributable to the surgical procedure and were not due to the preexisting medical condition of the patient. In addition, we were not interested in characterizing late postoperative recovery from phrenic nerve injury; but rather the impact of phrenic nerve injury on the early postoperative clinical course. Although a study of the natural history of phrenic nerve injury would make an interesting topic of research, it was not the aim of this study. Doctors Abd and Braun are concerned that we relied primarily on chest roentgenographic abnormalities for the diagnosis of phrenic nerve injury. The use of chest roentgenographic screening for identifying patients with possible phrenic nerve injury is widely accepted in the literature,1Esposito RA Spencer FC The effect of pericardial insulation on hypothermic phrenic nerve injury during open heart surgery.Ann Thorac Surg. 1987; 43: 303-308Abstract Full Text PDF PubMed Scopus (77) Google Scholar, 2Rousou JA Parker T Engelman RM Breyer RH Phrenic nerve paresis associated with the use of iced slush and the cooling jacket for topical hypothermia.J Thorac Cardiovasc Surg. 1985; 89: 921-925Abstract Full Text PDF PubMed Google Scholar, 3Guinn GA Beall AC Jr Lamki N Heibig J Thornby J Phrenic nerve injury during coronary artery bypass.Texas Heart Inst J. 1990; 17: 48-50PubMed Google Scholar, 4Wheeler WE Rubis LJ Jones CW Harrah JD Etiology and prevention of topical cardiac hypothermia-induced phrenic nerve injury and left lower lobe atelectasis during cardiac surgery.Chest. 1985; 88: 680-683Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar, 5Bogers AJJC Nicrop G Bakker W Huysmans HA Is diaphragmatic elevation a serious complication of open-heart surgery?.Scand J Thorac Cardiovasc Surg. 1989; 23: 271-274Crossref PubMed Scopus (8) Google Scholar as is confirmation of an injury with fluoroscopic observations, which were performed in all patients with clinical evidence of pulmonary dysfunction. As the aim of our article was to determine the impact of a change in technique on the clinical outcome, we believe that this is entirely appropriate. We have no experience with phrenic nerve latency for evaluation of phrenic nerve injury, but we are intrigued that Doctors Abd and Braun recommended it despite their own findings that “normal phrenic latency cannot be equated to normal diaphragmatic motion because latency may be normal in the presence of incomplete phrenic injury.”6Abd AG Braun NMT Baskin MI O'Sullivan MM Alkaitis DA Diaphragmatic dysfunction after open heart surgery: treatment with a rocking bed.Ann Intern Med. 1989; 111: 881-886Crossref PubMed Scopus (58) Google Scholar Doctors Abd and Braun seem to feel that no follow-up information is provided for any group. However, the time on the ventilator, time in the intensive care unit, time to hospital discharge, and mortality rates for all groups are given. Perhaps the authors are missing the point that this is a study of clinical outcomes of patients, not the clinical outcomes of phrenic nerves. Phrenic Nerve InjuryCHESTVol. 101Issue 5PreviewTo the Editor: Full-Text PDF" @default.
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