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Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure
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, th...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10301282/ https://www.ncbi.nlm.nih.gov/pubmed/37373973 http://dx.doi.org/10.3390/jpm13060984 |
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author | Akoumianaki, Evangelia Bolaki, Maria Prinianakis, Georgios Konstantinou, Ioannis Panagiotarakou, Meropi Vaporidi, Katerina Georgopoulos, Dimitrios Kondili, Eumorfia |
author_facet | Akoumianaki, Evangelia Bolaki, Maria Prinianakis, Georgios Konstantinou, Ioannis Panagiotarakou, Meropi Vaporidi, Katerina Georgopoulos, Dimitrios Kondili, Eumorfia |
author_sort | Akoumianaki, Evangelia |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10301282 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-103012822023-06-29 Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure Akoumianaki, Evangelia Bolaki, Maria Prinianakis, Georgios Konstantinou, Ioannis Panagiotarakou, Meropi Vaporidi, Katerina Georgopoulos, Dimitrios Kondili, Eumorfia J Pers Med Article 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. MDPI 2023-06-12 /pmc/articles/PMC10301282/ /pubmed/37373973 http://dx.doi.org/10.3390/jpm13060984 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Akoumianaki, Evangelia Bolaki, Maria Prinianakis, Georgios Konstantinou, Ioannis Panagiotarakou, Meropi Vaporidi, Katerina Georgopoulos, Dimitrios Kondili, Eumorfia Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure |
title | Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure |
title_full | Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure |
title_fullStr | Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure |
title_full_unstemmed | Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure |
title_short | Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure |
title_sort | hiccup-like contractions in mechanically ventilated patients: individualized treatment guided by transpulmonary pressure |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10301282/ https://www.ncbi.nlm.nih.gov/pubmed/37373973 http://dx.doi.org/10.3390/jpm13060984 |
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