A randomised controlled trial of intracuff lidocaine and alkalised lidocaine for sedation and analgesia requirements in mechanically ventilated patients (original) (raw)

2022, The Southern African journal of critical care

Airway irritation and inflammation caused by prolonged inflation of the endotracheal tube (ETT) cuff results in post-intubation morbidities such as sore throat, dysphagia, hoarseness of voice, severe cough, and pulmonary aspiration. [1,2] ETT presence is a cause of pain and discomfort in mechanically ventilated intensive care unit (ICU) patients. A significant amount of sedatives and analgesics are given to alleviate this. However, the cumulative effects of prolonged use of these drugs prolong the ICU length of stay and morbidity, such as respiratory muscle weakness, which increases patient-ventilator asynchrony and cough, which has been shown to result in potentially dangerous hyperdynamic responses such as hypertension, tachycardia, dysrhythmias, increased intraocular pressure, increased intracranial pressure, wound dehiscence, and bronchospasm. [3] Cough, as a result of stretch receptors located throughout the inner circumference of the trachea and just below the epithelium, is stimulated by irritants such as an ETT. To reduce the morbidities associated with mucosal irritation due to the ETT, different methods, including high-volume and lowpressure cuffed ETTs, smaller ETT size, topical application of lubricant jellies, administration of opioids, fluticasone, intravenous (IV) dexmedetomidine and injection of IV lidocaine, have been used. ETT cuffs filled with lidocaine have been proposed. [4-6] Lidocaine has long been used to obtund the unwanted airway and circulatory reflexes. It may be administered by IV injection, endotracheal cuff inflation, intratracheal (IT) instillation, tube lubrication, or in aerosolised form. [1,7] When lidocaine is injected into the ETT cuff, it spreads through the semipermeable membrane wall and induces