Wiley, Anaesthesia: Peri-operative medicine, critical care and pain, 2(66), p. 124-126, 2010
DOI: 10.1111/j.1365-2044.2010.06565.x
Full text: Download
Air swallowing can occur as a psychogenic phenomenon, because of abnormal anatomy, or during non-invasive positive pressure ventilation. Gross distension of the stomach with air can have severe consequences for the respiratory and gastrointestinal systems. We report the case of a 62-year-old man with severe dynamic hyperinflation due to chronic obstructive pulmonary disease, who developed respiratory failure requiring intubation a few hours after radical prostatectomy. Following a percutaneous tracheostomy and weaning of sedation on day six, his abdomen began to enlarge progressively. X-rays revealed massive gastric distension due to air swallowing, which continued despite all efforts to optimise therapy. The use of an underwater seal drainage system on a nasogastric tube improved ventilation and ultimately aided weaning from mechanical support.