Novel Treatment of Ventilator Dyssynchrony From Central Alveolar Hypoventilation Syndrome Utilizing Scheduled 5-Hydroxytryptamine-3 Receptor Antagonist

Traumatic brain injury (TBI) occurs in a large percentage of surgical trauma patients and is one of the leading causes of death amongst young teens and adults. Furthermore, individuals with TBIs often require mechanical ventilation and admission to the intensive care unit. As a result of their TBIs, these patients can develop central alveolar hypoventilation (CAH) secondary to disruptions in neuromodulatory respiratory brainstem control and neural signal initiation and integration. Prior studies have primarily focused their attention on treatment of congenital disorders of CAH, and limited research is available on intubated trauma patients who have signs of ventilator dyssynchrony. Current case reports and animal studies have suggested that noradrenergic and specific serotonergic medications are able to target specific neurologic pathways in the respiratory circuit and induce ventilator synchrony. This case series describes the clinical course of TBI patients treated for ventilator dyssynchrony secondary to CAH with a daily scheduled 5-hydroxytryptamine-3 (5-HT3) receptor antagonist. All patients were ultimately extubated and discharged from the hospital.