Reversion of Supra-Ventricular Tachycardia Through High Positive End-Expiratory Pressure During Mechanical Ventilation in Critically Ill Patients.

The Valsalva manoeuvre is widely recognised for its effectiveness in reverting supra-ventricular tachycardia (SVT) in patients with good coordination. However, this is not applicable in sedated ventilated patients and there is a dearth of literature regarding the application of Valsalva in unconscious patients on mechanical ventilation. The authors, for the first time, present a novel non-pharmacological method to treat SVT in critically ill patients on mechanical ventilation, employing the high positive end-expiratory pressure (PEEP) technique. This method successfully reverted SVT in two patients. While the exact mechanism remains unconfirmed, it is believed to be similar to that of the Valsalva manoeuvre. Further research is needed to validate this technique and determine the optimal ventilator settings, including the PEEP threshold, for such cases. Key Words: Valsalva manoeuvre, Supraventricular tachycardia, Positive end-expiratory pressure, Mechanical ventilation.