Efficacy of nebulized lidocaine, salbutamol, and beclomethasone plus salbutamol in post-COVID ARDS patients on non-invasive ventilation; a randomized controlled trial

Abstract

Objective: To compare the efficacy of nebulized lidocaine, salbutamol, and a combination of beclomethasone plus salbutamol in post-COVID ARDS patients, on non-invasive ventilation.

Methods: This randomized controlled trial was conducted on 81 post-COVID patients receiving non-invasive ventilation diagnosed with mild to moderate ARDS. Recruited patients had complaints of cough, hypoxia, and respiratory distress. Patients were allocated into three groups by lottery method as per treatment: ‘Lidocaine group’, ‘Salbutamol group’, and ‘beclomethasone + salbutamol group’. They received nebulization four times/day. Improvement in hypoxia was assessed by a rise in PaO₂ from baseline, improvement in respiratory distress was noted by > 10% amelioration in respiratory rate, and cough suppression was assessed on the ‘cough severity scale’.

Results: Improvement in hypoxia was 28.6% vs. 13.3% vs. 15% between Group-L vs. Group-S vs. Group-BS, respectively, with P = 0.001. Improvement in respiratory distress was 89% vs. 59% vs. 55%, and cough suppression was 85% vs. 30% vs. 44% between Group-L vs. Group-S vs. Group-BS, respectively, with a significant P-value. Complications were minimal; 7% in Group-L as compared to Group-S (55%) and Group-BS (48%), with a significant P = 0.001.

Conclusion: Lidocaine is found to be more effective than salbutamol and the combination of beclomethasone ± salbutamol in improvement of hypoxia, respiratory distress, and cough suppression with minimal hazardous effects, in post-COVID ARDS patients receiving non-invasive ventilation.

Clinical Trial Number: NCT04979923

Abbreviations: ARDS: adult respiratory distress syndrome, COVID-19: coronavirus 2019 disease, CSI: cough severity scale, IL-1: interleukin-1, HFO: high flow oxygen

Keywords: Lidocaine, Nebulization, Salbutamol, Beclomethasone, Cough, Hypoxia, Respiratory distress, ARDS

Citation: Sadaf S, Malik NA, Kousar R, Durrani HD. Efficacy of nebulized lidocaine, salbutamol, and beclomethasone plus salbutamol in post-COVID ARDS patients on non-invasive ventilation; a randomized controlled trial. Anaesth. pain intensive care 2025;29(8):890-896. DOI: 10.35975/apic.v29i8.3015

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025