From the Guidelines
A persistent cough following intubation is common and typically resolves within 1-2 weeks, and for immediate relief, I recommend using dextromethorphan (15-30mg every 4-6 hours) for cough suppression, combined with throat lozenges containing benzocaine or menthol, as suggested by various studies 1.
Causes of Persistent Cough
The causes of persistent cough following intubation can be multifactorial, including:
- Irritation of the tracheal and laryngeal mucosa by the endotracheal tube, leading to inflammation and hypersensitivity of the cough receptors 1
- Disruption of the protective mucociliary clearance system, resulting in increased mucus production and coughing as the body attempts to clear the airways 1
- Potential complications such as aspiration pneumonia or vocal cord injury, which can occur if the cough persists beyond two weeks, worsens, or is accompanied by fever, chest pain, or difficulty breathing 1
Management of Persistent Cough
For more severe symptoms, the doctor might prescribe:
- Benzonatate (100-200mg three times daily) or a short course of codeine-based cough suppressant 1
- Inhaled ipratropium to attenuate the cough, as suggested by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1
- Inhaled corticosteroids for patients with postinfectious cough that persists despite use of inhaled ipratropium and adversely affects the patient's quality of life 1
Importance of Medical Attention
It is essential to seek medical attention if the cough persists beyond two weeks, worsens, or is accompanied by fever, chest pain, or difficulty breathing, as this could indicate complications such as aspiration pneumonia or vocal cord injury 1.
Additional Considerations
Staying well-hydrated and using a humidifier can help soothe irritated airways, and patients should be evaluated for uncommon causes of cough, such as drug-induced cough or vocal cord dysfunction, if the cough persists after evaluation for common causes 1.
From the Research
Persistent Cough Days Post Intubation
- The provided studies do not directly address the issue of persistent cough days post intubation 2, 3, 4, 5, 6.
- However, some studies mention cough as a symptom or a potential complication related to intubation or respiratory conditions 2, 3, 4.
- For example, a study on chronic cough notes that cough can be a symptom of various conditions, including upper airway cough syndrome, gastroesophageal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis 2.
- Another study on cough-variant asthma discusses the therapeutic approach to cough-variant asthma, which includes inhaled corticosteroids and beta2 agonists 3.
- A study on COVID-19 patients mentions that intubated patients had a higher rate of diabetes and were older compared to non-intubated patients, but does not specifically address persistent cough post intubation 4.
- Other studies discuss paradoxical bronchoconstriction after inhaled albuterol 5 and the optimal timing of intubation in acute hypoxaemic respiratory failure 6, but do not provide direct evidence on persistent cough post intubation.