BOSTON, MA – Cough drops for a cough? Not so fast. An illuminating new multicenter, randomized-controlled, quintuple-blinded study in the New England Journal of Medical Management (NEJMM) states that compared to other antitussive agents, shoving an endotracheal tube down a patient’s throat is by far the most effective.
“It is clear from the data that if your patient is coughing and asks for something, over-the-counter medications like guaifenesin aren’t first line,” said Editor-in-Chief of the NEJMM Courtney Hack. “What we really need to do is intubate and be done with it. It will require a culture shift but I think most if not all health care professionals will get behind it.”
In the study led by Dr. Joanna Fleming and Dr. Randolph Throat-Tickle, over 12,000 patients across 12,000 centers in the United States and Europe were randomized to one of three arms: dextromethorphan (as needed), benzonatate (as needed), or an endotracheal tube (STAT). Where as the dextromethorphan and benzonatate arms improved cough by 23% and 22%, respectively, endotracheal tubes led to an astounding cough suppression rate of 100%.
“The problem with antitussive agents is that most act centrally or peripherally whereas the endotracheal tube goes straight to the source: the airway,” explained anesthesiologist Kendra Powers, who admits she went into her field of practice because she can’t stand being around people who make noise. “By taking control of their airway – BINGO! – you can eliminate their cough just like that.”
Intubation is not without risks, however, as exemplified when critical care fellow Eric Jennings recently intubated a patient’s rectum. To broker against these issues, consider (1) snowing them as you see fit, (2) using landmarks and cricoid pressure, and (3) getting rid of the blindfold altogether when placing the endotracheal tube.
Looking ahead, Fleming and Throat-Tickle are now enrolling participants in a study to determine if early elective rapid sequence intubation is effective at silencing talkative patients.
