Related Experiment Video
Updated: Mar 6, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Nebulized Fluticasone for Preventing Postextubation Stridor in Intubated Children: A Randomized, Double-Blind
Pharsai Prasertsan1, Duangjai Nakju, Rojjanee Lertbunrian
11Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 2Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Nebulized fluticasone propionate did not prevent postextubation stridor in children. However, it may benefit emergently intubated patients, potentially by reducing stridor severity.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Postextubation stridor is a common complication in children following mechanical ventilation.
- Effective prevention strategies are crucial to reduce respiratory distress and improve patient outcomes.
Purpose of the Study:
- To assess the efficacy of a single dose of nebulized fluticasone propionate in preventing postextubation stridor in pediatric patients.
- To evaluate the impact of nebulized fluticasone propionate on stridor severity and the need for noninvasive ventilation.
Main Methods:
- A double-blind, placebo-controlled randomized clinical trial was conducted in a pediatric intensive care unit (PICU).
- 147 children aged 1 month to 15 years undergoing mechanical ventilation received either nebulized fluticasone propionate (1,000 µg) or normal saline immediately after extubation.
- Patients were monitored for 6 hours post-extubation, with vital signs and modified Westley scores assessed. The primary outcome was the incidence of postextubation stridor.
Main Results:
- No significant difference in the prevalence of postextubation stridor was observed between the fluticasone and placebo groups (16% vs 18%, p = 0.797).
- In a subgroup of emergently intubated children, the fluticasone group experienced a longer delay in initiating noninvasive ventilation (p = 0.044).
- The modified Westley scores, indicating stridor severity, were significantly lower in the fluticasone group at 30 and 60 minutes post-extubation (p = 0.04 and p = 0.02, respectively).
Conclusions:
- A single dose of nebulized fluticasone propionate (1,000 µg) is not effective in reducing the overall incidence of postextubation stridor in children.
- Nebulized fluticasone propionate may offer benefits in emergently intubated children, potentially by mitigating stridor severity.
- Further research is warranted to explore the role of fluticasone propionate in specific pediatric populations requiring mechanical ventilation.
Objectives:
To evaluate the efficacy of nebulized fluticasone propionate in the prevention of postextubation stridor in children.
Design:
Double-blind, placebo-controlled randomized clinical trial.
Setting:
PICU in a tertiary referral center.
Patients:
Children 1 month to 15 years old who underwent mechanical ventilation.
Interventions:
Patients were randomly assigned into two groups after stratification based on age group receiving nebulized fluticasone 1,000 µg or normal saline solution, immediately after extubation. Vital signs and modified Westley score were evaluated for 6 hours after extubation. The primary outcome was the prevalence of postextubation stridor.
Measurements And Main Results:
One hundred forty-seven intubated children were enrolled into this study. Baseline characteristics between two groups were not different. There was no significant difference in the incidence of postextubation stridor (12/74 [16%] vs 13/73 [18%]; p = 0.797). However, when analyzing the subgroup of emergently intubated children, the fluticasone group had a longer delay median time for the initiation of noninvasive ventilation than the control group (380 [90-585] vs 60 [42-116] min; p = 0.044). The modified Westley scores at 30 and 60 minutes in the control group were significantly higher than the fluticasone group (4 vs 2, p = 0.04; 4.5 vs 0.5, p = 0.02, respectively).
Conclusions:
The single dose of 1,000-µg nebulized fluticasone did not decrease the prevalence of postextubation stridor. However, it might be beneficial in emergently intubated children.
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by...
01:23Inhaled Medications