Faculty Collaboration Database

Dexamethasone for the prevention of postextubation airway obstruction: a prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med 1996 Oct;24(10):1666-9

Date

10/01/1996

Pubmed ID

8874303

DOI

10.1097/00003246-199610000-00011

Scopus ID

2-s2.0-0029993897 (requires institutional sign-in at Scopus site)   133 Citations

Abstract

OBJECTIVE: To determine whether dexamethasone prevents postextubation airway obstruction in young children.

DESIGN: Prospective, randomized, double-blind, placebo-controlled study.

SETTING: Pediatric intensive care unit of a university teaching hospital.

PATIENTS: Sixty-six children, < 5 yrs of age, intubated and mechanically ventilated for > 48 hrs.

INTERVENTIONS: Patients were randomized to receive intravenous dexamethasone (0.5 mg/kg, maximum dose 10 mg) or saline, every 6 hrs for six doses, beginning 6 to 12 hrs before elective extubation.

MEASUREMENTS AND MAIN RESULTS: Dependent variables included the presence of stridor, Croup Score, and pulsus paradoxus at 10 mins, 6, 12, and 24 hrs after extubation; need for aerosolized racemic epinephrine and reintubation. The dexamethasone and placebo groups were similar in age (median 3 months [range 1 to 57] vs. 4 months [range 1 to 59], p = .6), frequency of underlying airway anomalies (3/33 vs. 3/33, p = 1.0), and duration of mechanical ventilation (median 3.3 days [range 2.1 to 39] vs. 3.5 days [range 2.1 to 15], p = .7). The dexamethasone group had a lower frequency of stridor, Croup Score, and pulsus paradoxus measurement at 10 mins and at 6 and 12 hrs after extubation. Fewer dexamethasone-treated patients required epinephrine aerosol (4/31 vs. 22/32, p < .0001) and reintubation (0/31 vs. 7/32, p < .01). Three patients exited the study early-one patient in the dexamethasone group had occult gastrointestinal hemorrhage and one patient in each group had hypertension.

CONCLUSION: Pretreatment with dexamethasone decreases the frequency of postextubation airway obstruction in children.

Author List

Anene O, Meert KL, Uy H, Simpson P, Sarnaik AP

Author

Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Airway Obstruction
Anti-Inflammatory Agents
Child, Preschool
Croup
Dexamethasone
Double-Blind Method
Female
Humans
Intubation, Intratracheal
Male
Prospective Studies
Respiration, Artificial
Respiratory Sounds