Diaphragm Function after Pulmonary Resection: Relationship to Postoperative Respiratory Failure

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Abstract
We studied the lung mechanics and respiratory muscle function in 20 patients undergoing pulmonary resection. Transdiaphragmatic pressure (ΔPdi) during quiet breathing did not show any remarkable change after the operation (9.5 ± 1.1 to 10.9 ± 1.0 cm H2O), while the ratio of abdominal to transdiaphragmatic pressure changes (ΔPab/ΔPdi) revealed a significant difference between the preoperative and the early postoperative periods (0.32 ± 0.06 to 0.00 ± 0.11, p < 0.05). The postoperative ΔPab/ΔPdi correlated significantly with the work of breathing (r = −0.60, p < 0.01). The maximal transdiaphragmatic pressure (Pdimax) decreased significantly after operation (75.0 ± 15.8 to 32.8 ± 12.4 cm H2O, p< 0.05), with no significant change in the maximal inspiratory mouth pressure (MIP) (74.2 ± 16.8 to 39.5 ± 11.6 cm H2O). Four of 20 patients developed respiratory failure postoperatively and required mechanical ventilation. ΔPab/ΔPdi in these patients was significantly lower than in the other patients (−0.62 ± 0.24 versus 0.16 ± 0.09, p < 0.005). Our results suggested that during quiet breathing diaphragmatic function was preserved and intercostal/accessory muscles recruitment increased, but maximal strength of the diaphragm might be reduced in patients undergoing pulmonary resection.