Effect of Capsaicin Atomization–Induced Cough on Sputum Excretion in Tracheotomized Patients After Hemorrhagic Stroke: A Randomized Controlled Trial

Wu, Caiyan; Zhang, Yijie; Li, Yang; Shen, Fang; Ma, Chen; Shen, Meifen

doi:10.1044/2021_jslhr-21-00151

Cited by 5 publications

(3 citation statements)

References 45 publications

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“…A possible hypothesis is that capsaicin should aid the clearance of the laryngopharynx and lower airways. In addition, a repeated trigger of the cough reflex might induce a central recovery of the cough reflex contributing to dysphagia rehabilitation as demonstrated in a recent case report in subjects affected by stroke [29] and in tracheostomized subjects affected by hemorrhagic stroke [30]. Another study conducted by Cui et al demonstrated an improvement in the swallowing function by combining ice and capsaicin stimulation in subjects with dysphagia after stroke [31].…”

Section: Discussionmentioning

confidence: 96%

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

L¹,

Cortese²,

Quintieri³

et al. 2023

Preprint

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The cough assessment is fundamental in the weaning process as it gives information on the possibility to expel food and secretion from the airways. The majority of persons suffering from severe acquired brain injury (ABI) are not able to cough voluntarily due to severe motor deficits. In the present study, we evaluated the cough reflex in ABI patients using a new method based on a capsaicin spray stimulation test. 100 Healthy controls demographically matched with 50 ABI patients were included in this study. Clinical observations demonstrated robust cough response in both healthy controls and ABI patients, as well as the safety and tolerability of capsaicin spray stimulation. ABI patients with dysphagia were characterized by slower and delayed cough responses. Further studies are needed to validate this feasible, less-invasive, and simple-to-comprehend technique in inducing cough reflex. According to this preliminary evidence, we believe that this test might be translated into a simple and effective treatment to improve cough strength training reflexive cough modulation in ABI patients.

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Section: Discussionmentioning

confidence: 96%

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

L¹,

Cortese²,

Quintieri³

et al. 2023

Preprint

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show abstract

“…To our knowledge, inhalation therapy with nebulized capsaicin for the purpose of minimizing aspiration and pneumonia risk in alert and cooperative patients post stroke has not been describe in the literature to date [ 47 ]. We are aware of one recently published randomized controlled trial by Wu et al [ 48 ], in which tracheotomized patients post hemorrhagic stroke with moderate to severe impairment of consciousness received one week of four times daily capsaicin nebulization via a tracheostomy mask. This trial reported some positive preliminary findings, with higher sputum output, fewer required suctioning passes and lower clinical pulmonary infection scores in the group that received capsaicin nebulization [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report

et al. 2022

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Dysphagia and aspiration risk are common sequelae of stroke, leading to increased risk of stroke-associated pneumonia. This is often aggravated by stroke-related impairment of cough, the most immediate mechanical defense mechanism against aspiration. In humans, reflex cough can be repeatedly and safely elicited by inhalation of nebulized capsaicin, a compound contained in chili peppers. Could this cough-eliciting property of capsaicin support the recovery of stroke survivors who present with dysphagia and aspiration risk? We present a clinical case report of a 73-year-old man, admitted to inpatient stroke rehabilitation following a right middle cerebral artery infarct with subsequent dysphagia and hospital-acquired pneumonia. A course of daily inhalation therapy with nebulized capsaicin was initiated, triggering reflex coughs to support secretion clearance and prevent recurrence of pneumonia. Clinical observations in each inhalation therapy session demonstrate good patient response, safety and tolerability of nebulized capsaicin in this mode of application. Repeated Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessments show concurrent improvement in the patient’s swallowing status. Inhalation therapy with nebulized capsaicin may offer a viable treatment to facilitate coughing and clearing of secretions, and to minimize aspiration and risk of aspiration-related pneumonia post stroke. Further investigation in a randomized controlled trial design is warranted.

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“…[3] However, some patients may experience difficulties with tube removal, and prolonged tracheostomy tube placement can lead to other complications, significantly impacting the patient's rehabilitation process. [4] This requires active intervention.…”

Section: Introductionmentioning

confidence: 99%

The impact of electrical stimulation at the back-shu acupoint with an extrinsic diaphragmatic pacing mode on respiratory function and extubation success rate in tracheostomized stroke patients: An observational study

Zhang,

Wang,

Liu

et al. 2024

Medicine

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To observe of the effect of electrical stimulation at the back-shu acupoint with extrinsic diaphragmatic pacing (EDP) mode on respiratory function and extubation success rate in tracheostomized stroke patients. A total of 200 patients who underwent tracheostomy after a stroke from January 2022 to February 2023 were included in this study. They were divided into 2 groups based on whether electroacupuncture was used: the EDP + electroacupuncture group and the EDP group. We assessed the differences in cough reflex scores and clinical lung infection scores between the 2 groups, and measured levels of blood gas analysis indicators, diaphragmatic function, lung function, maximum inspiratory pressure, and maximum expiratory pressure in both groups. The total effective rate in the EDP + electroacupuncture group was 91.00% (91/100), which was higher than the EDP group’s 80.00% (80/100) (P < .05). After treatment, both groups showed a decrease in clinical lung infection scores and cough reflex scores compared to before treatment, with the EDP + electroacupuncture group having lower scores than the EDP group (P < .05). After treatment, the pH value, arterial oxygen pressure, and oxygenation index all increased compared to before treatment, with the EDP + electroacupuncture group showing higher values than the EDP group (P < .05). After treatment, both groups showed a decrease in arterial carbon dioxide pressure compared to before treatment, with the EDP + electroacupuncture group having lower PaCO2 levels than the EDP group (P < .05). After treatment, both groups showed an increase in forced vital capacity as a percentage of predicted value (FVC%), diaphragm thickness, diaphragm mobility, maximum inspiratory pressure, maximum expiratory pressure, forced expiratory volume in the first second as a percentage of predicted value (FEV1%), and diaphragm contraction speed compared to before treatment. Additionally, the EDP + electroacupuncture group had higher values in these parameters compared to the EDP group (P < .05). The EDP + electroacupuncture group had a shorter average extubation time and a higher extubation success rate compared to the EDP group (P < .05). The combination of EDP mode and electroacupuncture at the back-shu acupoint appears to be effective in improving lung function and diaphragmatic function in tracheostomized stroke patients. It also leads to a shorter extubation time and higher extubation success rates.

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Effect of Capsaicin Atomization–Induced Cough on Sputum Excretion in Tracheotomized Patients After Hemorrhagic Stroke: A Randomized Controlled Trial

Cited by 5 publications

References 45 publications

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

Inducing Cough Reflex by Capsaicin Spray Stimulation in Patients with Acquired Brain Injury: A Preliminary Test and Proof of Concept

Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report

The impact of electrical stimulation at the back-shu acupoint with an extrinsic diaphragmatic pacing mode on respiratory function and extubation success rate in tracheostomized stroke patients: An observational study

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