PT - JOURNAL ARTICLE AU - Shadi Shafaghi AU - Parisa Adimi AU - Atefeh Fakharian AU - Amir Hassan Nassiri AU - Fariba Ghorbani AU - Seyed Shahabedin Mohammad Makki AU - Hamid Reza Khoddami Vishteh AU - Katayoun Najafizadeh TI - Effect of BIPAP on diaphragm paralysis after single lung transplantation DP - 2011 Sep 01 TA - European Respiratory Journal PG - p2456 VI - 38 IP - Suppl 55 4099 - http://erj.ersjournals.com/content/38/Suppl_55/p2456.short 4100 - http://erj.ersjournals.com/content/38/Suppl_55/p2456.full SO - Eur Respir J2011 Sep 01; 38 AB - Diaphragm is a chief muscle of inspiration and its unilateral or bilateral paralysis can lead to dyspnea and affect ventilator function. Here, we are reporting management of an emphysematous patient who is undergone single lung transplant and was suffering from diaphragmatic paralysis.A 53 year old male emphysematous patient was transplanted in 2009 and had no significant complication after transplantation. He was admitted 3 months and 9 months after transplantation due to acute rejection and received corticosteroid pulse therapy which the results were acceptable. 14 months after transplantation an elevated hemi diaphragm on chest x-ray was suggestive of diaphragmatic paralysis which was confirmed by paradoxical upward movement of right hemi diaphragm during fluoroscopic imaging. He had dyspnea with minimal exercise, reduced pulmonary function test (FVC from 63% to 38%) and oxygen saturation fall to 75% in rest without any oxygen supplement. Considering hypoxia and Co2 retention, polysomnography was performed to look for sleep apnea. Patient apnea hypopnea index (AHI) was 17 with 5 hypopnea, 5 central and 7 obstructive sleep events. After titration test, bi-level positive airway pressure apparatus (BIPAP) (PI=15, PE=11, st back up=14) was administered by oronasal mask. Althogh the authors worried about over expansion of high compliance emphysematous native lung with using BIPAP, pulmonary function test result improved significantly (FVC from 38% to 58%) and oxygen saturation during exercise increased to greater than 88% dramatically without expanding the native lung. We claim that BIPAP could be recommended for management of these patients without any considrable side effects.