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Dexamethasone in Prevention of Postextubation Stridor in Ventilated Children: A Randomized, Double-blinded,
Ritu1, Urmila Jhamb1
1Department of Paediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
Insights
This study found that dexamethasone did not significantly reduce the incidence of postextubation stridor (PES) in ventilated children. The drug showed no beneficial effect compared to placebo in preventing this common complication.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Postextubation stridor (PES) is a significant complication in pediatric patients requiring mechanical ventilation.
- PES can lead to prolonged intensive care unit (ICU) stays and increased healthcare costs.
Purpose of the Study:
- To evaluate the efficacy of dexamethasone in preventing postextubation stridor in children.
- To assess the impact of dexamethasone on the Westley Croup Score and reintubation rates.
Main Methods:
- A randomized, double-blinded, placebo-controlled trial was conducted in a pediatric ICU.
- Children aged 2 months to 12 years receiving mechanical ventilation for at least 48 hours were enrolled.
- Participants received either dexamethasone (0.15 mg/kg/dose) or placebo for 6 doses, with the first dose given 6-12 hours before planned extubation.
Main Results:
- The incidence of PES was 42.8% in the dexamethasone group and 55.2% in the placebo group (p=0.26).
- While not statistically significant, the Westley Croup Score >4 was observed less frequently in the dexamethasone group (28.5%) compared to placebo (47.3%) (p=0.08).
- There was no significant difference in reintubation rates between the two groups.
Conclusions:
- The studied dose of dexamethasone (0.15 mg/kg) did not demonstrate a beneficial effect in preventing postextubation stridor in ventilated children.
- Further research may be needed to explore different dosing strategies or patient populations.
Background And Aims:
Postextubation stridor (PES) is a serious complication in ventilated patients which increases the length of stay in intensive care units (ICUs). We studied the efficacy of dexamethasone in prevention of PES in ventilated children.
Materials And Methods:
A randomized, double-blinded, placebo-controlled trial was carried out in pediatric ICU. Children (2 months to 12 years) who underwent mechanical ventilation for 48 hours were randomized into two groups to receive either dexamethasone at 0.15 mg/kg/dose or normal saline for 6 doses with first dose given 6-12 hours prior to planned extubation. Patients were hourly monitored for vital signs and appearance of stridor using Westley croup score (WCS) within 72 hours after extubation. Whenever the score exceeded 4, nebulized adrenaline (1:1,000 at 0.5 mL/kg/dose) was given. The primary outcome was occurrence of PES.
Results:
Dexamethasone group comprised of 42 children while placebo group had 38 children. Baseline characteristics of two groups were similar. Overall PES occurred in 48.7% patients, 42.8% (18/42) in dexamethasone group, and 55.2% (21/38) in placebo group [p = 0.26, odds ratio (OR) 95% confidence interval (CI) = 0.60 (0.25-1.47)]. WCS >4 was present in 28.5% (12/42) of dexamethasone group vs 47.3% (18/38) of placebo group [p = 0.08, OR (95% CI) = 0.37 (0.12-1.06)]. There was no difference in reintubation rates in two groups [p = 0.9, OR (95% CI) = 1.06 (0.32-3.51)].
Conclusion:
We found no beneficial role of the studied dose of dexamethasone (0.15 mg/kg) over placebo on the incidence of PES.
How To Cite This Article:
Ritu, Jhamb U. Dexamethasone in Prevention of Postextubation Stridor in Ventilated Children: A Randomized, Double-blinded, Placebo-controlled Trial. Indian J Crit Care Med 2020;24(12):1230-1235.
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