Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Akoumianaki, Evangelia, Bolaki, Maria, Prinianakis, Georgios, Konstantinou, Ioannis, Panagiotarakou, Meropi, Vaporidi, Katerina, Georgopoulos, Dimitrios, Kondili, Eumorfia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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
_version_ 1785064774588956672
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
work_keys_str_mv AT akoumianakievangelia hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure
AT bolakimaria hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure
AT prinianakisgeorgios hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure
AT konstantinouioannis hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure
AT panagiotarakoumeropi hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure
AT vaporidikaterina hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure
AT georgopoulosdimitrios hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure
AT kondilieumorfia hiccuplikecontractionsinmechanicallyventilatedpatientsindividualizedtreatmentguidedbytranspulmonarypressure