Bilateral phrenic nerve block to reduce hazardous respiratory drive in a mechanically ventilated patient with COVID-19—A case report

Abstract

Key Clinical Message
Forced inspiration during mechanical ventilation risks self‐inflicted lung injury. However, controlling it with sedation or paralysis may cause polyneuropathy and myopathy. We tested bilateral phrenic nerve paralysis with local anesthetic in a patient, showing reduced inspiratory force. This offers an alternative to drug‐induced muscle paralysis.Mechanical ventilation, although a life‐saving measure, can also pose a risk of causing lung injury known as “ventilator‐induced lung injury” or VILI. Patients undergoing mechanical ventilation sometimes exhibit heightened inspiratory efforts, wherein the negative pressure generated by the respiratory muscles adds to the positive pressure generated by the ventilator. This combination of high pressures can lead to a syndrome similar to VILI, referred to as “patient self‐inflicted lung injury” or P‐SILI. Prevention of P‐SILI requires the administration of deep sedation and muscle paralysis to the patients, but both these measures can have undesired effects on their health. In this case report, we demonstrate the effect of a bilateral phrenic nerve block aiming to reduce excessive inspiratory respiratory efforts in a patient suffering from COVID‐19 pneumonitis.