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Respiratory Therapist/depressed diaphrgm syndrom


Do you have a treatmnet for this problem, no one seems to have any idea

Good morning,

Thank you for trusting me with your personal medical question.  This difficult to assess and treat condition depends on the severity, but to my knowledge some patients with severe diaphragmatic dysfunction require ventilatory support on a breathing machine, because their diaphragm muscle is not strong enough to engage in normal breathing. Depending on the source of the disease, some patients only require short-term support, while others may require life-long ventilatory breathing help.

Most patients with bilateral diaphragmatic paralysis eventually develop progressive ventilatory failure resulting from fatigue of the accessory muscles. Patients may have progressive disease with carbon dioxide retention and irreversible ventilatory failure. These patients require ventilatory assistance.

In one study, improvement was demonstrated after ventilatory support with external negative-pressure respirators in patients with carbon dioxide retention and decreased central ventilatory drive. Some patients who have decreased ventilatory strength had these measures of respiratory function normalize after a period of negative-pressure ventilatory assistance.

Patients with cor pulmonale (a form of heart failure) also may show improvement in function and correction of some abnormalities with nighttime or intermittent daytime non-invasive ventilation, such as CPAP or BiPAP.

If the patient does not respond to nasal or oral positive-pressure ventilation, alternative forms of therapy such as negative-pressure cuirass or pulmo-wrap, rocking bed, or positive-pressure pulmo-belt can be used.

Tracheotomy with positive-pressure intermittent or permanent ventilation is reserved for patients with life-threatening disease.

Patients should undergo a sleep study if he or she is considered for negative-pressure ventilation because it can precipitate or exacerbate pre-existing upper airway obstruction. Positive-pressure ventilation can minimize the need for a sleep study.

If the phrenic nerve in the diaphragm muscle is working properly and the problem lies in actually transmitting an impulse to the nerve, phrenic nerve or diaphragmatic pacing may be useful modalities in the treatment of this subset of patients.

Progressive reconditioning is recommended when using a diaphragmatic pacer. High stimulating frequencies and a prolonged period of pacing may lead to irreversible muscle dysfunction. Patients with diaphragmatic pacing require tracheotomies because pacer-induced breathing is not synchronized with the upper airway. Investigations with diaphragmatic pacers and upper airway sensors are ongoing.

Once a diagnosis of neurologic dysfunction is made, ordering studies to determine the cause is vital. A number of neurologic etiologies can be managed medically, but discovering the cause is often a challenge.

As far as surgery options, these are only possibilities in patients with actual anatomic defects in the diaphragm. The type of surgical intervention depends on the anatomic defect or problem.  

I hope this at least gave you a little bit of information to work with, but in this case I would prefer to have a Pulmonologist or Neurologist address your specific issues directly.

Best of health to you,

Larry, RRT

Respiratory Therapist

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Larry W. Wical, BA-RRT


I CAN answer: ALL questions and queries related to the following topics... - Oxygen - Asthma - COPD - Bronchitis - Emphysema - Pneumonia (Viral/Bacterial) - Tuberculosis (TB) - SARS - Influenza (Flu) - Vaccines - Pulmonary Embolism - Pleural Effusion - Atelectasis - Inhalation injuries (burns, chemicals, etc.) - PFTs - Cardiovascular health - Sleep Apnea - BiPap/CPAP - Ventilators (Respirators) - Aspiration injuries - Thoracic injuries - Lung contusions - Tracheal injuries - Artificial Tracheostomy - Secretions - Prolotherapy/Regenerative Injection Therapy (RIT): A patient's experience/perspective - General health and fitness - Prolotherapy (from a patient's perspective) I CANNOT answer: Questions that vary too far from my primary scope of pulmonary and cardiovascular care and fitness. I promise to be open and honest about my knowledge of submitted topics, and will always openly provide my personal as well as professional feedback as it relates.


Registered Respiratory Therapist (RRT, RCP) since 2005. I have worked primarily in the acute care, critical care, burn care and home care settings.

NBRC - National Board of Respiratory Care AARC - American Association of Respiratory Care

-All About Kids Magazine -The Clermont Sun -Cincy Sports & Fitness Magazine -Many online Fitness and Health blogs and "webazines"

- B.A. in Communication (1997) - A.A.S. in Respiratory Science (2005) - RRT license (state of OH, KY and IN) - Basic Life Saving (BLS) - Advanced Cardiovascular Life Support (ACLS) - Advanced Burn Life Support (ABLS)

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Currently work in the city's largest academic/research hospital.

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