Cough Syrup Recommendations for Post-Tracheostomy Patient on Antiplatelet Therapy
Dextromethorphan is the recommended cough suppressant for a patient with a history of PTCA on aspirin, ticagrelor, Starpress XL, and atorvastatin who is experiencing cough after tracheostomy. 1
Considerations for Tracheostomy Patients with Cough
- Post-tracheostomy cough is common and requires careful management, especially in patients with cardiovascular disease on antiplatelet therapy 2
- Coughing in tracheostomy patients is considered an aerosol-generating procedure that requires special attention to minimize complications 2
- Topical lidocaine may be used to reduce coughing during tracheostomy tube manipulation, but must be carefully dosed, especially in pediatric populations 2
Medication Considerations for Patients on Antiplatelet Therapy
- The patient is on dual antiplatelet therapy (aspirin and ticagrelor) following PTCA, which is standard care to prevent thrombotic events 2
- Ticagrelor should not be discontinued as patients with coronary stents require continued antiplatelet therapy to prevent stent thrombosis 2
- For patients with a history of percutaneous coronary intervention, maintaining dual antiplatelet therapy is crucial to prevent major adverse cardiovascular events 2
Cough Management Recommendations
- Dextromethorphan is the preferred cough suppressant as it has minimal interaction with antiplatelet medications and cardiovascular drugs 1
- Avoid medications with sedative properties that could compromise respiratory function in a patient with tracheostomy 2, 3
- Avoid saline instillation before suctioning as it increases risk of coughing and provides little benefit while potentially increasing aerosolization 2
Tracheostomy Care Considerations
- Use closed-circuit suctioning with an inline suction catheter to manage secretions and minimize aerosolization risk 2
- Ensure proper humidification using Heat Moisture Exchanger (HME) with viral filter rather than nebulized humidification to reduce coughing and secretion buildup 2, 4
- Maintain proper cuff inflation (20-30 cmH2O for air-filled cuffs) to ensure integrity of the ventilation system while preventing tracheal injury 2
Cautions and Contraindications
- Avoid medications with antihistamine or anticholinergic properties that can thicken secretions and potentially lead to tube obstruction 3, 5
- Be vigilant for signs of tube obstruction, which is one of the most serious complications in tracheostomy patients 6, 3
- Have emergency supplies readily available at the bedside, including suctioning equipment, oxygen source, and a complete tracheostomy kit 3
By following these recommendations, you can effectively manage the patient's post-tracheostomy cough while minimizing risks associated with their cardiovascular condition and antiplatelet therapy.