CHEST Guidelines-Treatment-of-Idiopathic-Diaphragm-Flutter

Treatment-of-Idiopathic-Diaphragm-Flutter_chest (2)

Pdf Summary

This case study documents a pioneering treatment for idiopathic diaphragmatic flutter, a rare disorder characterized by involuntary, rapid contractions of the diaphragm causing severe dyspnea and thoracoabdominal pain. Historically, treatments such as medications, phrenic nerve interventions, and diaphragm pacing have seen limited success. A 35-year-old woman suffering from diaphragmatic flutter had unrelieved symptoms despite numerous treatments, including medications like levetiracetam and clonazepam, phrenic nerve crush, and diaphragm pacing, all of which lacked efficacy and occasionally caused adverse side effects.<br /><br />The novel approach involved resting the diaphragm using noninvasive ventilatory support (NVS). Initial interventions with a manual resuscitator and then home NVS instantly halted her flutter episodes for extended periods. Over 16 months, this method continued to be effective, halting flutter episodes triggered during activities like getting out of bed. While the treatment did not eliminate her pain, which remained a significant issue, it successfully managed the flutter without adverse effects, unlike previous therapies.<br /><br />This treatment marks the first instance where diaphragmatic rest has been employed successfully over the long term for this disorder. Although diaphragm rest using NVS wasn't curative, it managed the flutter symptoms more effectively than prior attempts. The case highlights that resting the diaphragm with NVS might be adopted as a first-line treatment strategy for diaphragmatic flutter while underlining the limitations in addressing associated pain symptoms. The study opens the door for further exploration into the long-term viability and adaptation of NVS in similar cases.

Keywords

idiopathic diaphragmatic flutter

diaphragm contractions

noninvasive ventilatory support

NVS

phrenic nerve interventions

diaphragm pacing

flutter episodes

diaphragmatic rest

long-term treatment

pain management