Can a patient with hypoxia and possible aspiration pneumonia, who is coughing and currently nil per os (NPO), receive an order for cough medication?

From the Guidelines

I strongly recommend requesting an order for a cough suppressant medication, such as dextromethorphan or codeine, for this NPO patient with hypoxia and possible aspiration pneumonia who is experiencing coughing, as it can help alleviate discomfort and prevent worsening of hypoxia. The patient's NPO status and possible aspiration pneumonia require careful consideration of the medication administration route, with a liquid formulation being the most suitable option [ 1 ]. When contacting Dr. Chengat, it is essential to specify the patient's current oxygen requirements, vital signs, and whether the cough is productive or non-productive to help determine the most appropriate medication.

According to the guidelines, central cough suppressants, such as codeine and dextromethorphan, are recommended for the short-term symptomatic relief of coughing in patients with chronic bronchitis [ 1 ]. Although the patient's condition is not chronic bronchitis, the principle of using central cough suppressants for symptomatic relief can be applied. It is crucial to balance cough suppression with the need to clear secretions, especially in a patient with possible aspiration pneumonia.

The use of lignocaine or bupivacaine as mentioned in the 1997 study [ 1 ] may not be the most appropriate option for this patient, as the more recent guidelines from 2006 [ 1 ] provide more specific recommendations for cough suppressant therapy. Additionally, the patient's NPO status and possible aspiration pneumonia require a more tailored approach to medication administration.

Key considerations for the medication order include:

• The patient's current oxygen requirements and vital signs
• Whether the cough is productive or non-productive
• The need for a liquid formulation due to NPO status
• The potential benefits and risks of cough suppression in a patient with possible aspiration pneumonia
• The importance of balancing cough suppression with the need to clear secretions.

From the Research

Patient Treatment

• The patient is experiencing hypoxia and possible aspiration pneumonia, and is coughing but has no cough medicine ordered PRN on EMAR.
• The patient is NPO (nothing by mouth), which may limit treatment options.

Relevant Studies

• A study from 1988 2 found that inhaled anticholinergic bronchodilators, such as ipratropium bromide, may be effective in treating pathologic cough.
• A 2019 study 3 found that combining ipratropium bromide with terbutaline did not reduce hospital admission or need for ICU care in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring noninvasive ventilation.
• A 2001 review 4 found that adding ipratropium bromide to inhaled beta2-agonist therapy may be effective in treating acute asthma exacerbation in adults and children.
• A 2017 study 5 found significant variability in treatment for inpatient pediatric asthma hospitalizations, including the use of ipratropium bromide, across US pediatric hospitals.

Potential Treatment Options

• Considering the patient's cough and possible aspiration pneumonia, ipratropium bromide may be a potential treatment option, as suggested by the 1988 study 2 and the 2001 review 4.
• However, the patient's NPO status and lack of cough medicine ordered PRN on EMAR may require further evaluation and consideration of alternative treatment options.