Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure

Author:

Akoumianaki Evangelia12ORCID,Bolaki Maria1,Prinianakis Georgios1,Konstantinou Ioannis1,Panagiotarakou Meropi1ORCID,Vaporidi Katerina12,Georgopoulos Dimitrios2,Kondili Eumorfia12ORCID

Affiliation:

1. Department of Intensive Care Unit, University Hospital of Heraklion, 71110 Crete, Greece

2. School of Medicine, University of Crete, 71003 Heraklion, Greece

Abstract

Hiccups-like contractions, including hiccups, respiratory myoclonus, and diaphragmatic tremor, refer to involuntary, spasmodic, and inspiratory muscle contractions. They have been repeatedly described in mechanically ventilated patients, especially those with central nervous damage. Nevertheless, their effects on patient-ventilator interaction are largely unknown, and even more overlooked is their contribution to lung and diaphragm injury. We describe, for the first time, how the management of hiccup-like contractions was individualized based on esophageal and transpulmonary pressure measurements in three mechanically ventilated patients. The necessity or not of intervention was determined by the effects of these contractions on arterial blood gases, patient-ventilator synchrony, and lung stress. In addition, esophageal pressure permitted the titration of ventilator settings in a patient with hypoxemia and atelectasis secondary to hiccups and in whom sedatives failed to eliminate the contractions and muscle relaxants were contraindicated. This report highlights the importance of esophageal pressure monitoring in the clinical decision making of hiccup-like contractions in mechanically ventilated patients.

Publisher

MDPI AG

Subject

Medicine (miscellaneous)

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