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Role of Intravenous Dexamethasone in Prevention of Postextubation Airway Obstruction in Mechanically Ventilated
Anjali R Varghese1, Pratyusha Kambagiri1, Manas R Sahoo1
1Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Insights
Intravenous dexamethasone did not prevent reintubation in children but may reduce clinically significant stridor after mechanical ventilation. This study explored its efficacy in preventing postextubation airway obstruction.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Postextubation airway obstruction (PEAO) is a significant complication in pediatric intensive care units (PICUs).
- Steroids, particularly dexamethasone, are often considered for preventing airway inflammation and edema postextubation.
Purpose of the Study:
- To evaluate the efficacy of intravenous dexamethasone in preventing postextubation airway obstruction (PEAO) in mechanically ventilated children.
- To assess the impact of dexamethasone on reintubation rates, stridor severity, and patient outcomes.
Main Methods:
- A double-blinded randomized controlled trial was conducted in a level 3 PICU involving 70 children requiring mechanical ventilation for at least 24 hours.
- Participants were randomized to receive either intravenous dexamethasone (0.5 mg/kg/dose, four doses) or a placebo, with the primary outcome being clinically significant stridor (Westley score ≥3).
Main Results:
- No significant difference was observed in the incidence of clinically significant stridor between the dexamethasone (25.71%) and placebo (31.42%) groups (p=0.792).
- Reintubation rates were similar (11.42% vs 14.28%, p=0.734), as were mortality rates and the length of PICU and hospital stays.
- A trend towards reduced stridor was noted in the dexamethasone group, though not statistically significant.
Conclusions:
- Multiple doses of intravenous dexamethasone may not effectively prevent reintubation in children postextubation.
- Dexamethasone might offer a potential benefit in reducing the incidence of clinically significant stridor, warranting further investigation.
- Current evidence suggests limited benefit of dexamethasone for preventing PEAO in this population.
Objective:
To study the efficacy of intravenous dexamethasone in preventing postextubation airway obstruction (PEAO).
Design:
A double-blinded randomized controlled trial.
Study Setting:
The study was conducted in level 3 PICU at AIIMS, Raipur, India, from December 2019 to September 2022.
Subjects:
Children requiring intubation for at least 24 hours and not beyond 14 days were included. Children with upper airway anomalies or who received corticosteroids within the last 7 days were excluded.
Intervention:
The children who satisfied the inclusion criteria were randomized into dexamethasone or placebo group by stratified variable block randomization. Dexamethasone (0.5 mg/kg/dose) or placebo was given four doses (-12 hr., -6 hr., 0 hr., and 6 hr. of extubation).
Outcome:
The occurrence of any clinically significant stridor (Westley stridor score ≥3) was the primary outcome.
Measurements And Main Results:
Of the seventy (n = 70) children included in the study, 35 received dexamethasone while 35 received placebo. Westley stridor score ≥3 was present in 25.71% (n = 9) in dexamethasone group vs 31.42% (n = 11) in placebo (p = 0.792). Reintubation occurred in 14.28% (n = 10/70) patients, 11.42% (4/35) in dexamethasone group, and 17.14% (6/35) in placebo group (p = 0.734). Five children in the dexamethasone group and six in placebo group died (p = 1.00). There was no difference in the length of PICU stay (p = 0.84) and hospital stay (p = 0.75) among both the groups.
Conclusion:
Administration of multiple doses of dexamethasone may not help in the prevention of reintubation but may help in the reducing the incidence of clinically significant stridor.
How To Cite This Article:
Varghese AR, Kambagiri P, Sahoo MR, Jindal A, Goel AK. Role of Intravenous Dexamethasone in Prevention of Postextubation Airway Obstruction in Mechanically Ventilated Children in Pediatric Intensive Care Unit: A Double-blind Randomized Controlled Trial. Indian J Crit Care Med 2024;28(11):1063-1068.
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