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Association of Prophylactic Corticosteroids with Post-Extubation Outcomes in Pediatric Cardiac Critical Care: A

Kwannapas Saengsin1, Noraworn Jirattikanwong2, Pakpoom Wongyikul2

  • 1Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

Journal of Clinical Medicine
|June 26, 2026
PubMed

Insights

Prophylactic corticosteroids did not reduce post-extubation stridor (PES) or extubation failure in pediatric cardiac patients. This study suggests PES is not a key mediator of treatment effects, warranting further investigation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiology
  • Pharmacology

Background:

  • Post-extubation stridor (PES) is a frequent complication in pediatric critical care, potentially leading to extubation failure, especially in children with heart disease.
  • The efficacy of prophylactic corticosteroids in preventing PES and extubation failure in this vulnerable population remains unclear.
  • This study investigates the association between prophylactic corticosteroid use and PES/extubation failure in pediatric cardiac patients.

Purpose of the Study:

  • To evaluate the association of prophylactic corticosteroids with post-extubation stridor (PES) and extubation failure in pediatric cardiac patients.
  • To explore whether PES acts as a mediator in the relationship between corticosteroid use and extubation failure.
  • To inform clinical practice regarding corticosteroid use in this specific patient group.

Main Methods:

  • Retrospective, single-center observational cohort study of 494 extubation events in a pediatric cardiac critical care unit.
  • Exposure: prophylactic intravenous corticosteroids (dexamethasone or methylprednisolone) administered 6-24 hours before planned extubation.
  • Outcomes: clinically defined PES (primary) and extubation failure (reintubation within 48 hours, secondary). Propensity score weighting and structural equation modeling were used for analysis.

Main Results:

  • Prophylactic corticosteroid use was not significantly associated with reduced odds of PES (OR 1.06) or extubation failure (OR 0.49) after propensity score weighting.
  • In patients with PES, corticosteroid use showed a non-significant trend towards reduced extubation failure (OR 0.70).
  • Exploratory mediation analysis did not support PES as a significant mediator of any treatment effect.

Conclusions:

  • Prophylactic corticosteroid administration before extubation was not associated with a reduction in PES or extubation failure in pediatric cardiac patients.
  • The findings suggest that clinically defined PES does not appear to be a key mediator of corticosteroid treatment effects in this population.
  • Further prospective studies are necessary to definitively establish the role of prophylactic corticosteroids in preventing extubation-related complications in pediatric cardiac critical care.

Keywords:
corticosteroidsextubation failurepediatric cardiac intensive care unitpost-extubation stridor

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