Bilateral phrenic nerve block as an effective means of controlling inspiratory efforts in a COVID-19 patient. (2021)

• Record Type: Journal Article
• Authors: Nakayama, Ryuichi; Iwamoto, Yusuke; Bunya, Naofumi; Sawada, Atsushi; Takahashi, Kazunobu; Goto, Yuya; Kasai, Takehiko; Kakizaki, Ryuichiro; Uemura, Shuji; Narimatsu, Eichi
• Is Part Of: Respiratory medicine case reports. Volume 33(2021)
• Publication Date: 2021
• Subjects: COVID-19 -- Acute respiratory distress syndrome -- Patient self-inflicted lung injury -- Neuromuscular blocking agents -- Phrenic nerve block -- Case report; ⊿Pes change in oesophageal pressure -- ARDS acute respiratory distress syndrome -- COVID-19 coronavirus disease -- CT computed tomography -- Edi electrical activity of the diaphragm -- ICU intensive care unit -- ICU-AW intensive care unit-acquired weakness -- NMBAs neuromuscular blocking agents -- Pes oesophageal pressure -- P-SILI patient self-inflicted lung injury -- PEEP positive end-expiratory pressure; Respiratory organs -- Diseases -- Periodicals; Chest -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory System -- Periodicals; Chest -- Diseases; Respiratory organs -- Diseases; Electronic journals; Periodicals; 616.2
• DOI: 10.1016/j.rmcr.2021.101455
• Languages: English
• ISSNs: 2213-0071

Abstract

Abstract: Bilateral continuous phrenic nerve block effectively regulates refractory persistent, strong inspiratory effort in a patient with coronavirus disease (COVID-19). A 73-year-old man with acute respiratory distress syndrome (ARDS) due to COVID-19 was admitted to the intensive care unit (ICU). Use of neuromuscular blocking agents (NMBAs) was stopped due to uncontrollable strong inspiratory efforts and worsened lung injury. We performed bilateral continuous phrenic nerve block, which suppressed inspiratory efforts, resulting in lung injury improvement. A bilateral continuous phrenic nerve block is a viable alternative to control refractory strong inspiratory effort leading to lung injury in cases with prolonged NMBA use.