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Post-extubation stridor in Respiratory Syncytial Virus bronchiolitis: Is there a role for prophylactic dexamethasone?

Esther S Veldhoen1, Charlotte A Smulders1, Teus H Kappen2

  • 1Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.

Plos One
|February 17, 2017
PubMed

Insights

Reintubation due to airway obstruction is a risk for infants with Respiratory Syncytial Virus bronchiolitis. Prophylactic dexamethasone before extubation may significantly lower this reintubation risk.

Area of Science:

  • Pediatric Critical Care Medicine
  • Neonatology
  • Respiratory Medicine

Background:

  • Respiratory Syncytial Virus (RSV) bronchiolitis is a common cause of respiratory insufficiency in infants.
  • Invasive mechanical ventilation is often required for severe cases.
  • Upper airway obstruction and reintubation are potential complications post-extubation.

Purpose of the Study:

  • To determine the incidence of reintubation due to upper airway obstruction in infants with RSV bronchiolitis.
  • To investigate the association between prophylactic dexamethasone and the risk of reintubation.

Main Methods:

  • Retrospective observational study in two Dutch Pediatric Intensive Care Units.
  • Included 200 infants (<13 months) with RSV bronchiolitis requiring mechanical ventilation.
  • Logistic regression with propensity score analysis was used to control for confounding factors.

Main Results:

  • The incidence of reintubation due to post-extubation stridor was 8.5% (17/200 patients).
  • Prophylactic dexamethasone administration prior to extubation was significantly associated with a reduced risk of reintubation (p=0.0011).
  • An absolute risk reduction of 13% (95% CI 5.3-21%) was observed in the dexamethasone group.

Conclusions:

  • Post-extubation stridor necessitating reintubation is a significant complication in ventilated infants with RSV bronchiolitis.
  • Prophylactic dexamethasone prior to extubation likely reduces the risk of reintubation.
  • Further placebo-controlled trials are warranted to confirm the efficacy of prophylactic dexamethasone.
Abstract

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