Lidocaine inhalation for cough

Q:  Nebulized lidocaine is frequently used for refractory cough. Name at least one caveat that should be considered while using it in the ICU?

Answer: Aspiration pneumonia or pneumonitis

Nebulized lidocaine is an effective tool in ICU for refractory cough. Its two major side effects are an unpleasant taste and symptomatic aspiration. 

Lidocaine is usually prescribed as 3 mL of 4 percent lidocaine in nebulizer form, which is equivalent to 120 mg. It can be increased up to a 5 mL dose with an equivalency of 200 mg. Every 12 to 8 hours should be sufficient. It numbs the throat, so the patient should be instructed to report or closely watch for choking on water or food.

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References:

1. Lim KG, Rank MA, Hahn PY, et al. Long-term safety of nebulized lidocaine for adults with difficult-to-control chronic cough: a case series. Chest 2013; 143:1060.

2. Abdulqawi R, Satia I, Kanemitsu Y, Khalid S, Holt K, Dockry R, Woodcock AA, Smith JA. A Randomized Controlled Trial to Assess the Effect of Lidocaine Administered via Throat Spray and Nebulization in Patients with Refractory Chronic Cough. J Allergy Clin Immunol Pract. 2021 Apr;9(4):1640-1647. doi: 10.1016/j.jaip.2020.11.037. Epub 2020 Nov 28. PMID: 33259976.

3. Udezue E. Lidocaine inhalation for cough suppression. Am J Emerg Med. 2001 May;19(3):206-7. doi: 10.1053/ajem.2001.21724. PMID: 11326346.