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Trials of corticosteroids to prevent postextubation airway complications
M O Meade1, G H Guyatt, D J Cook
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Insights
Corticosteroids significantly reduced postextubation stridor in children. However, evidence remains uncertain regarding their effectiveness in preventing other complications like reintubation in both children and adults.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacological Interventions
- Respiratory Management
Background:
- Postextubation complications, including stridor and reintubation, pose significant risks in pediatric and adult patients.
- Corticosteroid administration prior to extubation is a potential strategy to mitigate these adverse events.
Purpose of the Study:
- To evaluate the efficacy of preextubation corticosteroid administration in reducing postextubation complications.
- To synthesize evidence from randomized controlled trials (RCTs) and non-RCTs in pediatric and adult populations.
Main Methods:
- Systematic review and pooled analysis of three RCTs in children undergoing primary extubation.
- Inclusion of one non-RCT examining children with prior extubation failure.
- Analysis of four RCTs conducted in adult populations.
Main Results:
- Corticosteroids significantly reduced stridor in children (RR, 0.57; 95% CI, 0.40 to 0.81).
- A trend towards less reintubation was observed in children (RR, 0.50; 95% CI, 0.02 to 13.87).
- A non-RCT showed reduced prolonged reintubation and failed reextubations in children. Evidence in adults was inconclusive due to low reintubation rates.
Conclusions:
- Preextubation corticosteroids effectively decrease the risk of postextubation stridor in children by approximately 40%.
- The role of corticosteroids in reducing other postextubation complications, such as reintubation, in both pediatric and adult patients remains uncertain.
- Further research is warranted to clarify the benefits of corticosteroids for preventing reintubation postextubation.
Abstract:
We identified three randomized controlled trials (RCTs) that addressed whether preextubation steroid administration reduces postextubation complications in children. The pooled analysis of primary extubation in children demonstrated significantly less stridor (relative risk [RR], 0.57; 95% confidence interval [CI], 0.40 to 0.81) and a trend toward less reintubation (RR, 0.50; 95% CI, 0.02 to 13.87) with corticosteroids. One non-RCT in children who had failed extubation the first time found a significant reduction in duration of prolonged reintubation (> or = 6 days) and in failed reextubations. The four RCTs in adults reported very low reintubation rates, and no conclusions can be drawn. Only one RCT assessed postextubation stridor and found little difference. Overall, we found that corticosteroids decreased the risk of postextubation stridor in children by about 40%. However, the effect of corticosteroids in children and adults to reduce postextubation complications such as reintubation is uncertain.