Related Experiment Video
Updated: Nov 29, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Effectiveness of corticosteroids for post-extubation stridor and extubation failure in pediatric patients: a
Satoshi Kimura1,2, JiYoon B Ahn3, Mai Takahashi3,4
1Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. kimsato1034@hotmail.co.jp.
Insights
Corticosteroids may help prevent post-extubation stridor and extubation failure in pediatric patients. This systematic review suggests their use is acceptable in children, despite varied study designs.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Previous meta-analyses indicated corticosteroid benefits for post-extubation stridor and failure in adults.
- Pediatric anatomy differs from adults, necessitating specific research in children.
Purpose of the Study:
- To evaluate the efficacy of corticosteroids in preventing post-extubation stridor and extubation failure in pediatric populations.
- To synthesize evidence from randomized controlled trials and observational studies in mechanically ventilated children.
Main Methods:
- Systematic search of PubMed, EMBASE, and article reference lists up to February 2019.
- Inclusion of randomized controlled trials and observational studies on systemic corticosteroids before elective extubation in pediatric patients.
- Outcomes assessed were post-extubation stridor and extubation failure.
Main Results:
- Ten randomized controlled trials (591 pediatric patients) were analyzed.
- Corticosteroids showed a pooled odds ratio of 0.40 for post-extubation stridor/suspected upper airway obstruction.
- A significantly lower odds of extubation failure (OR, 0.37) was observed in pediatric patients receiving corticosteroids.
Conclusions:
- Despite small sample sizes and varied regimens, corticosteroid use appears acceptable for preventing post-extubation stridor and failure in children.
- Further research may refine optimal dosing and timing for specific pediatric age groups.
- The findings support considering corticosteroids as a preventive measure in pediatric mechanical ventilation.
Background:
While the results of previous meta-analyses have shown beneficial effects of corticosteroid therapy on post-extubation stridor and extubation failure in adults, these results might not be generalizable to children because of the differences in anatomy and structure. We aimed to determine the benefits of corticosteroids on those outcomes in pediatric populations.
Methods:
We searched PubMed, EMBASE, and reference lists of articles from inception until February 2019. Randomized controlled trials and observational studies on the efficacy of systemic corticosteroid administration given prior to elective extubation in mechanically ventilated pediatrics were eligible. Outcomes included post-extubation stridor indicating laryngeal edema and extubation failures.
Results:
A total of ten randomized controlled trials with 591 pediatric patients were included: seven of the ten studies for post-extubation stridor/suspected upper airway obstruction and nine of the ten studies for extubation failure. The estimate of pooled odds ratios (ORs) for post-extubation stridor/suspected upper airway obstruction was 0.40 (95% CI: 0.21-0.79). When analysis was restricted to trials that had explicit data for infants and explicit data for pediatric patients under 5 years old excluding infants, the estimates of pooled ORs were 0.53 (95% CI: 0.20-1.40) and 0.68 (95% CI: 0.38-1.22), respectively. For pediatric patients who received corticosteroids, there was a 0.37-fold lower odds of extubation failure than that in pediatric patients who did not receive corticosteroids (OR, 0.37; 95% CI, 0.22-0.61). While three observational studies were included in this review, their estimates have a potential for bias and we did not perform a meta-analysis.
Conclusions:
Despite a relatively small sample size in each randomized controlled trial and wide ranges of ages and steroid administration regimens, our results suggest that the use of corticosteroids for prevention of post-extubation stridor and extubation failure could be considered to be acceptable in pediatric patients.
Related Concept Videos
01:26COPD: Management Using Bronchodilators and Corticosteroids
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....
01:25Antiasthma 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...
01:17Endotracheal 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...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...