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

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.

Keywords

• COVID-19
• Acute respiratory distress syndrome
• Patient self-inflicted lung injury
• Neuromuscular blocking agents
• Phrenic nerve block
• Case report