From the Guidelines
A persistent cough following intubation should be managed with throat lozenges, warm salt water gargles, and adequate hydration, with consideration of over-the-counter cough suppressants or expectorants as needed, while monitoring for potential complications such as infection or vocal cord injury, as indicated by observational studies 1. When managing a persistent cough post-intubation, it's essential to consider the potential causes, including laryngeal injury and inflammation, which can occur in up to 94% of patients intubated for more than four days 1. The injury patterns seen in these patients include laryngeal edema and posterior and medial vocal fold ulceration, which can lead to persistent cough and other respiratory symptoms. Some key management strategies for persistent cough post-intubation include:
- Using throat lozenges containing benzocaine or menthol to help soothe the throat
- Performing warm salt water gargles (1/4 teaspoon salt in 8 ounces warm water) several times daily to reduce inflammation
- Ensuring adequate hydration with at least 8 glasses of water daily to thin secretions
- Considering over-the-counter options such as dextromethorphan (Delsym, 30mg every 12 hours) for cough suppression or guaifenesin (Mucinex, 600mg every 12 hours) to thin secretions, as needed. It's crucial to monitor the patient's symptoms and seek medical attention if the cough lasts beyond two weeks, worsens, or is accompanied by fever, chest pain, or difficulty breathing, as these could indicate complications like infection or vocal cord injury, as suggested by the study on hoarseness (dysphonia) 1.
From the Research
Persistent Cough Days Post Intubation
- The provided studies do not directly address the issue of persistent cough days post intubation, but they do offer some insights into coughing and intubation 2, 3, 4, 5, 6.
- Chronic cough, which is defined as a cough lasting longer than eight weeks in adults, can be caused by various conditions, including upper airway cough syndrome, gastroesophageal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis 2.
- A study on chronic cough and a normal chest X-ray found that the most frequent diagnoses were asthma, gastro-oesophageal reflux, and angiotensin-converting enzyme inhibitor use 3.
- Medications such as lidocaine, dexmedetomidine, remifentanil, and fentanyl have been studied for their effectiveness in reducing emergence coughing after general anaesthesia with tracheal intubation, with dexmedetomidine ranked as the most effective 4.
- Voluntary cough peak flow (V-CPF) has been found to be a better predictor of re-intubation than involuntary cough peak flow (IV-CPF) in cooperative subjects 5.
- A study on the effect of coughing at extubation on oxygenation in the post-anaesthesia care unit found no association between coughing at extubation and impaired oxygenation in the immediate postoperative period 6.