Hipo (singulto), una causa de asincronía y deterioro de la oxigenación en paciente con ventilación mecánica invasiva: reporte de caso

Abstract

We present the case of a 19-year-old woman, with a history of LADA type diabetes mellitus, who presented an acute decompensation of her metabolic pathology secondary to pneumonia of viral origin due to SARS COV2, with a torpid clinical evolution due to hypoxemic respiratory failure. with the need for invasive mechanical ventilation and secondary ARDS (Acute Respiratory Distress Syndrome), in whom hiccups (Singultos), ventilatory asynchrony and impaired oxygenation were evidenced.

In our patient, hiccups were considered the cause of ventilatory asynchrony, and treatment with levomepromazine was started with adequate resolution of the singultus, leading to a marked improvement in oxygenation and successful extubation.

Hiccups are a benign, common and self-limited phenomenon that affects almost all people throughout their lives, which can be associated with unfavorable results, such as malnutrition, fatigue, weight loss, insomnia, depression, anxiety, edema. and decreased quality of life and in patients with invasive mechanical ventilation it can result in respiratory alkalosis from hyperventilation, ventilator-associated pneumonia, impaired oxygenation indices, and asynchrony.

Hiccups are a little-recognized pathology in patients undergoing ventilatory support, with unfavorable results, evidenced by prolonged stays and the need for invasive mechanical ventilation and management in the intensive care unit (ICU), and of course everything that this includes.

Knowledge of hiccups, as a possible cause of asynchrony and oxygenation disorder in ventilated patients, can allow timely recognition, which allows management in the acute phase, is a fundamental part of minimizing complications associated with ventilation and prolonged stays in ICU.