The effect of pericardial insulation on hypothermic XXXX during open-heart surgery.

@entity1 @entity296 @entity16 @entity128 @entity764 @entity356 @entity1576 @entity912 @entity2332
@entity128 was evaluated prospectively in 133 @entity1 undergoing open-heart surgery using iced saline slush for topical @entity2332 . In the control group of 70 @entity1 no attempt was made to shield the phrenic nerves from direct exposure to ice. Phrenic @entity16 occurred in 73% of these @entity1 , as assessed by persistent diaphragm @entity912 evident on inspiratory chest roentgenogram. In 2 @entity1 the @entity912 was bilateral. In the second group of 63 @entity1 a pericardial insulation pad was used to prevent contact of the iced slush to the phrenic nerve. Diaphragm @entity912 was observed in 17% of these @entity1 . This difference was highly significant (p less than .001). Diaphragm @entity912 in the control group was clinically significant; life-threatening @entity1576 developed in 7 @entity1 (14%), frequently resulting in multiple reintubations, tracheostomy, and prolonged mechanical ventilation. In addition, 4 @entity1 with @entity128 exhibited a clinical syndrome consistent with @entity356 , which may possibly represent hypothermic @entity764 . The likelihood of @entity128 when iced saline slush is used for topical @entity296 and the possibility of developing serious @entity1576 would support the routine use of pericardial insulation when this method of @entity2332 is used.
