Hiccup patient-ventilator asynchrony

Had a fully sedated COVID-patient getting totally out of sync with the ventilator today. After checking all the settings and tubings, the nurse finally made me notice that the patient had spastic diaphragmatic contractions. After a dose of Metoclopramide and changing the orogastric tube from a Salem to a Freka, it went away.

Note to future self: Maybe try a valsalva manoeuvre with the vent?

Refs:

1. Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015 Nov;42(9):1037–50.
2. Petroianu GA. Treatment of hiccup by vagal maneuvers. J Hist Neurosci. 2015;24(2):123–36.