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Does prophylactic use of dexamethasone have a role in reducing post extubation stridor and reintubation in children?
Ali Faisal Saleem1, Surrayo Bano, Anwarul Haque
1Department of Material and Child Health, The Aga Khan University Hospital, Karachi, Pakistan.
Insights
Prophylactic dexamethasone did not reduce postextubation stridor or reintubation rates in high-risk children requiring mechanical ventilation. This study found no significant benefit in using dexamethasone for planned extubations in this pediatric population.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Respiratory medicine
Background:
- Postextubation stridor and reintubation are significant complications in pediatric patients requiring mechanical ventilation.
- High-risk children, defined by prolonged intubation or specific underlying conditions, may benefit from interventions to prevent these adverse events.
Purpose of the Study:
- To evaluate the efficacy of prophylactic dexamethasone in preventing postextubation stridor and reducing reintubation rates in high-risk pediatric patients undergoing planned extubation.
- To assess the safety and effectiveness of dexamethasone administration prior to extubation in children aged 4 weeks to 5 years.
Main Methods:
- A prospective study comparing dexamethasone (DEX) treated patients (n=30) with a control group (n=21) who did not receive medication.
- Patients received DEX (0.5 ml/kg every 6 hours for 3 doses) starting 6-12 hours before extubation.
- Demographic data, duration of intubation/mechanical ventilation, and incidence of postextubation stridor and reintubation were recorded and compared between groups.
Main Results:
- No significant difference was observed in the incidence of postextubation stridor between the DEX group (17%) and the control group (10%; p = 0.5).
- The reintubation rates were also similar between the groups: 7% in the DEX group versus 10% in the control group (p = 0.7).
- The mean age and duration of intubation/mechanical ventilation were comparable between the dexamethasone and control groups.
Conclusions:
- Prophylactic use of dexamethasone is not effective in preventing postextubation stridor or reducing reintubation rates in high-risk children undergoing planned extubation.
- Current evidence suggests that dexamethasone administration prior to planned extubation does not offer significant clinical benefits for this pediatric population.
- Further research may be needed to identify effective strategies for managing high-risk pediatric patients at the time of extubation.
Abstract:
All children aged from 4 weeks to <5 year, were intubated for at least 48 hours [n=51] during 6 months. Data of the patients treated with DEX (0.5 ml/kg every 6 hours for 3 doses, beginning 6-12 hours prior to extubation) (n=30) were compared with control patients (who had not received medication) (n=21). The DEX and control groups were similar in age i.e., mean ages of DEX group were 16.85+/-14 months, and that of control group were 19.02 +/- 19 months, mean duration of intubation and mechanical ventilation in DEX group was 5.17 +/- 4.58 days, and that in control group was 3.98 +/- 3.60 days. There was no significant difference between DEX and control group in the incidence of postextubation stridor [17% (5/30) vs. 10% (2/21); p = 0.5] and the reintubation rate [7% (2/30) vs. 10% (2/21); p = 0.7]. Our data revealed that the prophylactic use of dexamethasone in planned extubation of high risk children were not effective.
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