Adverse events associated with prophylactic corticosteroid use before extubation: a cohort study

Area of Science:

• Critical Care Medicine
• Pharmacology
• Endocrinology

Background:

• Systemic corticosteroids are recommended before extubation to prevent airway complications.
• Adverse events associated with prophylactic corticosteroid use remain unclear.
• This study investigates adverse events in mechanically ventilated adults receiving corticosteroids before extubation.

Purpose of the Study:

• To describe the incidence of adverse events.
• To identify common adverse events associated with prophylactic corticosteroid use before extubation.
• To evaluate the safety profile of this intervention in critically ill patients.

Main Methods:

• Retrospective cohort study of 251 mechanically ventilated adults.
• Patients received 80 mg methylprednisolone over 12 hours before extubation.
• Follow-up for 72 hours post-extubation, monitoring for increased blood glucose, infections, and delirium.

Main Results:

• 23.1% and 30.3% of patients had significant blood glucose increases within 24 and 72 hours, respectively.
• Increased blood glucose was linked to diabetes mellitus but not prior hyperglycemia or age.
• New-onset infections (7.6%) and delirium (7.7%) were also observed.

Conclusions:

• Prophylactic corticosteroids before extubation are associated with adverse events, primarily elevated blood glucose.
• Consideration of lower corticosteroid doses is suggested for patients with diabetes or hyperglycemia.
• Further research may refine dosing strategies to balance benefits and risks.