Hiccups in the Neuro-Critical Care Unit: A Symptom Less Studied?

Background: Hiccups (also referred to as “hiccoughs”) are usually a transient condition that affects almost everyone in their lifetime. However, persistent and intractable hiccups are the types which are often linked with unfavorable outcomes and can also result in respiratory alkalosis in the intubated patients. There is no accurate estimate of the prevalance of hiccups in the patients admitted in the neuro-ICU.The most commonly witnessed hiccups in the neuro-ICU are intractable and neurogenic in nature. In this communication, we discuss the strategy of respiratory care and pharmacological management of hiccups in an adult male post decompressive craniotomy in view of unilateral basal ganglion bleed.  He suffered from persistent hiccups and was managed conservatively with intravenous Metachlorpromide 10 mg on as and when needed (SOS) basis. In conclusion, it seems that persistent and intractable hiccups as a risk factor for ventilator-associated pneumonia in patients who are intubated and mechanically ventilated should be given due attention. We encourage clinical trials in this area of critical care medicine and should also encourage more studies to analyse the effectiveness of non-pharmacological methods.