Abstract
A 62-year-old woman with previous history of paranoid schizophrenia controlled with antipsychotics was admitted to ICU care due to acute respiratory failure secondary to SARS-CoV-2 pneumonia. During ventilatory weaning, the patient developed a severe an unexplained tachypnea with persistent paradoxical breathing pattern. After excluding delirium, upper airway, lung, and central nervous system (CNS) complications, the diagnosis of respiratory dyskinesia was considered. Cessation of chronic antipsychotic medication and introduction of tetrabenazine and clonazepam markedly improved the patient’s respiratory pattern, allowing the withdrawal of ventilatory support and a good recovery.
Acute complications of long-term antipsychotic medication are rare among ICU patients. The present case required a multidisciplinary approach between critical care and psychiatry departments to establish a definitive diagnosis and to outline a therapeutic plan.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure—a structured approach. Crit Care. 2010;14(6):245. https://doi.org/10.1186/cc9296.
Stahl SM. Neuronal traffic signals in tardive dyskinesia: not enough “stop” in the motor striatum. CNS Spectr. 2017;22(6):427–34. https://doi.org/10.1017/S109285291700061X.
van Harten PN, Tenback DE. Tardive dyskinesia: clinical presentation and treatment. Int Rev Neurobiol. 2011;98:187–210. https://doi.org/10.1016/B978-0-12-381328-2.00008-0.
Hayashi T, Nishikawa T, Koga I, Uchida Y, Yamawaki S. Prevalence of and risk factors for respiratory dyskinesia. Clin Neuropharmacol. 1996;19(5):390–8. https://doi.org/10.1097/00002826-199619050-00002.
Savitt D, Jankovic J. Tardive syndromes. J Neurol Sci. 2018;389:35–42. https://doi.org/10.1016/j.jns.2018.02.005.
Bhidayasiri R, Boonyawairoj S. Spectrum of tardive syndromes: clinical recognition and management. Postgrad Med J. 2011;87(1024):132–41. https://doi.org/10.1136/pgmj.2010.103234.
Varrone J, Lavoie K, Manthous CA. Tardive tachypnea. Intensive Care Med. 2016;42(12):2126. https://doi.org/10.1007/s00134-016-4555-5.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
das Neves Coelho, F., Melo Santos, C., Gaspar, I. (2023). Weaning from Mechanical Ventilation: Antipsychotic-Induced Respiratory Dyskinesia in a Patient with Severe SARS-CoV-2 Pneumonia. In: Pérez-Torres, D., Martínez-Martínez, M., Schaller, S.J. (eds) Best 2022 Clinical Cases in Intensive Care Medicine. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-031-36398-6_24
Download citation
DOI: https://doi.org/10.1007/978-3-031-36398-6_24
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-36397-9
Online ISBN: 978-3-031-36398-6
eBook Packages: MedicineMedicine (R0)