J Neurocrit Care.  2021 Jun;14(1):18-28. 10.18700/jnc.200018.

Hiccups in neurocritical care

• Rajagopalan V
• Sengupta D
• Goyal K
• Dube SK
• Bindra A
• Kedia S

• KMID: 2517129
• DOI: http://doi.org/10.18700/jnc.200018

Abstract

Hiccups are usually self-limiting and benign but can be distressing when they become persistent or intractable and produce significant morbidity. In the intubated patients in neurocritical care, persistent hiccups may cause respiratory alkalosis, and is also associated with increased incidence of ventilator associated pneumonia. Several pharmacological and non-pharmacological strategies have been devised for the treatment of persistent and intractable hiccups. The evidence to support or declare any intervention as harmful is scarce. In this review we have presented the pathophysiology and work-up, and a stepwise management protocol for intractable hiccups.

Keyword

Hiccup; Intractable hiccups; Neurocritical care; Persistent hiccups; Drug therapy

Figure

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  Fig. 1. Hiccup reflex arc. Activation of “hiccup center” by lesions in the central nervous system (CNS) or periphery triggers hiccups mediated via phrenic and intercostal nerves, leading to myoclonic repetitive contractions of the diaphragm and accessory muscles. The characteristic “hic” sound is produced due to reflex closure of the glottis via recurrent laryngeal nerve.

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  Fig. 2. Stepwise management protocol. GERD, gastroesophageal reflux disease; CT, computed tomography; MRI, magnetic resonance imaging.

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