PURPOSE:Multidose steroid pretreatment is effective in preventing postextubation airway obstruction (PEAO) in adults, however controversy continues for children. This study was designed as a randomized, placebo-controlled, double-blind trial to compare the effect of 24-h pretreatment with dexamethasone (24hPD) versus 6-h pretreatment (6hPD) on PEAO and reintubation in children at a tertiary care hospital in a developing economy. METHODS:Hundred twenty-four children (3 months to 12 years) intubated for ≥48 h and planned to have extubation during next 24 h were randomized to receive 24hPD (0.5 mg/kg/dose, q6h, total of six doses; n = 66) or 6hPD (total of three doses; n = 58). Patients with preexistent upper airway conditions, chronic respiratory diseases, steroid therapy in last 7 days, gastrointestinal bleeding, hypertension, and hyperglycemia and those likely to have poor airway reflexes were excluded. RESULTS: The two groups were similar at baseline. 24hPD reduced the incidence of PEAO (43/66 versus 48/58; p = 0.027) with absolute risk reduction of 17 %. It also reduced the incidence of reintubation, though nonsignificantly, by half [5/61 versus 9/58; relative risk (RR), 1.09; 95 % confidence interval (CI), 0.96-1.25]. Time to recovery from PEAO among non-reintubated patients was shorter among 24hPD patients (p = 0.016). No adverse event was noted with dexamethasone use. Intubation duration >7 days and cuffed tracheal tubes were found to be independent risk factors for PEAO (odds ratio 6 and 3.12, respectively). CONCLUSIONS: 24-h pretreatment with multidose dexamethasone reduced the incidence of PEAO and the time to recover from it. 24hPD should be considered for high-risk children intubated for >48 h in the study setting. Further studies with larger sample size from different socioeconomic background are desirable to validate these findings.
RCT Entities:
PURPOSE: Multidose steroid pretreatment is effective in preventing postextubation airway obstruction (PEAO) in adults, however controversy continues for children. This study was designed as a randomized, placebo-controlled, double-blind trial to compare the effect of 24-h pretreatment with dexamethasone (24hPD) versus 6-h pretreatment (6hPD) on PEAO and reintubation in children at a tertiary care hospital in a developing economy. METHODS: Hundred twenty-four children (3 months to 12 years) intubated for ≥48 h and planned to have extubation during next 24 h were randomized to receive 24hPD (0.5 mg/kg/dose, q6h, total of six doses; n = 66) or 6hPD (total of three doses; n = 58). Patients with preexistent upper airway conditions, chronic respiratory diseases, steroid therapy in last 7 days, gastrointestinal bleeding, hypertension, and hyperglycemia and those likely to have poor airway reflexes were excluded. RESULTS: The two groups were similar at baseline. 24hPD reduced the incidence of PEAO (43/66 versus 48/58; p = 0.027) with absolute risk reduction of 17 %. It also reduced the incidence of reintubation, though nonsignificantly, by half [5/61 versus 9/58; relative risk (RR), 1.09; 95 % confidence interval (CI), 0.96-1.25]. Time to recovery from PEAO among non-reintubated patients was shorter among 24hPDpatients (p = 0.016). No adverse event was noted with dexamethasone use. Intubation duration >7 days and cuffed tracheal tubes were found to be independent risk factors for PEAO (odds ratio 6 and 3.12, respectively). CONCLUSIONS: 24-h pretreatment with multidose dexamethasone reduced the incidence of PEAO and the time to recover from it. 24hPD should be considered for high-risk children intubated for >48 h in the study setting. Further studies with larger sample size from different socioeconomic background are desirable to validate these findings.
Authors: Jean-François Timsit; Anders Perner; Jan Bakker; Matteo Bassetti; Dominique Benoit; Maurizio Cecconi; J Randall Curtis; Gordon S Doig; Margaret Herridge; Samir Jaber; Michael Joannidis; Laurent Papazian; Mark J Peters; Pierre Singer; Martin Smith; Marcio Soares; Antoni Torres; Antoine Vieillard-Baron; Giuseppe Citerio; Elie Azoulay Journal: Intensive Care Med Date: 2015-03-26 Impact factor: 17.440
Authors: Esther S Veldhoen; Charlotte A Smulders; Teus H Kappen; Job C Calis; Job van Woensel; Paulien A M Raymakers-Janssen; Louis J Bont; Marije P Hennus Journal: PLoS One Date: 2017-02-16 Impact factor: 3.240