A case report of an 18-year-old receiving nebulized lidocaine for treatment of COVID-19 cough.
Kelli J Welter, Sharon Gordon, Patrick Snyder and 1 others
PMID 36201924WHAT IT FOUND
In one adolescent with severe COVID cough, nebulized lidocaine was started with albuterol, gabapentin, and ipratropium.
The team reported less propofol use afterward, but multiple treatments changed together and this single case cannot show lidocaine worked.
Key findings
01Nebulized lidocaine was started together with albuterol, gabapentin, and ipratropium.
02The paper reported an average of 5.5 propofol boluses per day before lidocaine and an average of 2.4 propofol boluses per day after lidocaine started.
03Serum lidocaine levels remained below 1 mcg/mL while scheduled doses were given.
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What it does not show
This is a single case report, so it cannot show that nebulized lidocaine worked. Nebulized lidocaine, albuterol, gabapentin, and ipratropium were started together, so the effect of any one component cannot be separated. The team did not use a validated cough frequency or severity tool and used sedation needs as a proxy. Propofol infusion rate, bolus dosing, muscle relaxants, ECMO sweep settings, and other sedation changes were also altered during the same period. The patient had severe illness requiring ECMO and continuous renal replacement therapy, so findings may not apply to less sick patients. The patient ultimately withdrew life-sustaining treatments and died, so the case does not show long-term recovery.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not conclude that nebulized lidocaine reduced cough or sedation. The patient received lidocaine, albuterol, gabapentin, and ipratropium together, and sedation, muscle relaxants, and ECMO settings were also changed. No validated cough measure was used, and this is one case.