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Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study

INTRODUCTION: Prophylactic steroid therapy to reduce the occurrence of postextubation laryngeal edema is controversial. Only a limited number of prospective trials involve adults in an intensive care unit. The purpose of this study was to ascertain whether administration of multiple doses of dexamet...

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Autores principales: Lee, Chao-Hsien, Peng, Ming-Jen, Wu, Chien-Liang
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206529/
https://www.ncbi.nlm.nih.gov/pubmed/17605780
http://dx.doi.org/10.1186/cc5957
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author Lee, Chao-Hsien
Peng, Ming-Jen
Wu, Chien-Liang
author_facet Lee, Chao-Hsien
Peng, Ming-Jen
Wu, Chien-Liang
author_sort Lee, Chao-Hsien
collection PubMed
description INTRODUCTION: Prophylactic steroid therapy to reduce the occurrence of postextubation laryngeal edema is controversial. Only a limited number of prospective trials involve adults in an intensive care unit. The purpose of this study was to ascertain whether administration of multiple doses of dexamethasone to critically ill, intubated patients reduces or prevents the occurrence of postextubation airway obstruction. Another specific objective of our study was to investigate whether an after-effect (that is, a transient lingering benefit) exists 24 hours after the discontinuation of dexamethasone. METHODS: A randomized, placebo-controlled, double-blind trial was conducted in an adult medical intensive care unit of a tertiary care hospital. Eighty-six patients who had been intubated for more than 48 hours with a cuff leak volume (CLV) of less than 110 ml and who met weaning criteria were randomly assigned to receive either dexamethasone (5 mg; n = 43) or placebo (normal saline; n = 43) every six hours for a total of four doses on the day preceding extubation. CLV was measured before the first injection, one hour after each injection, and 24 hours after the fourth injection. Extubation was carried out 24 hours after the last injection. Postextubation obstruction (defined as the presence of stridor) was recorded within 48 hours of extubation. RESULTS: Administration of dexamethasone during the 24-hour period preceding extubation resulted in a statistically significant increase in the CLV (p < 0.05). The significant increase of CLV and change of CLV relative to baseline tidal volume (percentage) occurred not only throughout the treatment period, but also 24 hours after the last dexamethasone injection. The incidence of postextubation stridor was significantly lower in the dexamethasone group than in the placebo group (10% [4/40] versus 27.5% [11/40]; p = 0.037), whereas there was no significant difference in reintubation rate between the two groups (2.5% [1/40] versus 5% [2/40]; p = 0.561). CONCLUSION: Prophylactic administration of multiple-dose dexamethasone is effective in reducing the incidence of postextubation stridor in adult patients at high risk for postextubation laryngeal edema. The after-effect of dexamethasone may validate the reduced incidence of postextubation stridor after multiple doses of dexamethasone. TRIAL REGISTRATION: NCT00452062.
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spelling pubmed-22065292008-01-19 Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study Lee, Chao-Hsien Peng, Ming-Jen Wu, Chien-Liang Crit Care Research INTRODUCTION: Prophylactic steroid therapy to reduce the occurrence of postextubation laryngeal edema is controversial. Only a limited number of prospective trials involve adults in an intensive care unit. The purpose of this study was to ascertain whether administration of multiple doses of dexamethasone to critically ill, intubated patients reduces or prevents the occurrence of postextubation airway obstruction. Another specific objective of our study was to investigate whether an after-effect (that is, a transient lingering benefit) exists 24 hours after the discontinuation of dexamethasone. METHODS: A randomized, placebo-controlled, double-blind trial was conducted in an adult medical intensive care unit of a tertiary care hospital. Eighty-six patients who had been intubated for more than 48 hours with a cuff leak volume (CLV) of less than 110 ml and who met weaning criteria were randomly assigned to receive either dexamethasone (5 mg; n = 43) or placebo (normal saline; n = 43) every six hours for a total of four doses on the day preceding extubation. CLV was measured before the first injection, one hour after each injection, and 24 hours after the fourth injection. Extubation was carried out 24 hours after the last injection. Postextubation obstruction (defined as the presence of stridor) was recorded within 48 hours of extubation. RESULTS: Administration of dexamethasone during the 24-hour period preceding extubation resulted in a statistically significant increase in the CLV (p < 0.05). The significant increase of CLV and change of CLV relative to baseline tidal volume (percentage) occurred not only throughout the treatment period, but also 24 hours after the last dexamethasone injection. The incidence of postextubation stridor was significantly lower in the dexamethasone group than in the placebo group (10% [4/40] versus 27.5% [11/40]; p = 0.037), whereas there was no significant difference in reintubation rate between the two groups (2.5% [1/40] versus 5% [2/40]; p = 0.561). CONCLUSION: Prophylactic administration of multiple-dose dexamethasone is effective in reducing the incidence of postextubation stridor in adult patients at high risk for postextubation laryngeal edema. The after-effect of dexamethasone may validate the reduced incidence of postextubation stridor after multiple doses of dexamethasone. TRIAL REGISTRATION: NCT00452062. BioMed Central 2007 2007-07-02 /pmc/articles/PMC2206529/ /pubmed/17605780 http://dx.doi.org/10.1186/cc5957 Text en Copyright © 2007 Lee et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Lee, Chao-Hsien
Peng, Ming-Jen
Wu, Chien-Liang
Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
title Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
title_full Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
title_fullStr Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
title_full_unstemmed Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
title_short Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
title_sort dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206529/
https://www.ncbi.nlm.nih.gov/pubmed/17605780
http://dx.doi.org/10.1186/cc5957
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