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Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis

This study aimed to determine the frequency of prophylactic steroid administration to prevent reintubation after extubation in critically ill patients. We systematically searched MEDLINE, Embase and Cochrane Library for studies regarding the preventive use of multiple doses or single-dose steroids p...

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Autores principales: Ahn, Chiwon, Na, Min Kyun, Choi, Kyu-Sun, Lim, Tae Ho, Jang, Bo-Hyoung, Kim, Wonhee, Cho, Youngsuk, Shin, Hyungoo, Kim, Jae Guk, Lee, Juncheol
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268958/
https://www.ncbi.nlm.nih.gov/pubmed/34209761
http://dx.doi.org/10.3390/jcm10132900
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author Ahn, Chiwon
Na, Min Kyun
Choi, Kyu-Sun
Lim, Tae Ho
Jang, Bo-Hyoung
Kim, Wonhee
Cho, Youngsuk
Shin, Hyungoo
Kim, Jae Guk
Lee, Juncheol
author_facet Ahn, Chiwon
Na, Min Kyun
Choi, Kyu-Sun
Lim, Tae Ho
Jang, Bo-Hyoung
Kim, Wonhee
Cho, Youngsuk
Shin, Hyungoo
Kim, Jae Guk
Lee, Juncheol
author_sort Ahn, Chiwon
collection PubMed
description This study aimed to determine the frequency of prophylactic steroid administration to prevent reintubation after extubation in critically ill patients. We systematically searched MEDLINE, Embase and Cochrane Library for studies regarding the preventive use of multiple doses or single-dose steroids prior to extubation on July 2020 and conducted a network meta-analysis (NMA) to compare these interventions. To assess the risk of bias of each included study, version 2 of the Cochrane risk-of-bias tool for randomized trials was used. Nine randomized control trials comprising 2098 patients with comparisons of the three interventions were included. Use of multiple doses and single doses of intravenous steroids administration showed a significantly lower rate of reintubation compared with placebo (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.25–0.72; OR: 0.31, 95% CI: 0.14–0.69). However, the comparison between multiple doses and single doses showed no significant differences (OR: 1.22, 95% CI: 0.32–4.74). According to the surface under the cumulative ranking curve statistic, the treatments should be ranked as follows: single dose (87.1%), high dose (62.8%) and placebo (0.1%). This NMA showed that the multiple doses were not statistically superior to the single dose in lowering the incidence of reintubation after extubation in critically ill patients. Therefore, use of a single-dose steroid can reduce the incidence of reintubation.
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spelling pubmed-82689582021-07-10 Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis Ahn, Chiwon Na, Min Kyun Choi, Kyu-Sun Lim, Tae Ho Jang, Bo-Hyoung Kim, Wonhee Cho, Youngsuk Shin, Hyungoo Kim, Jae Guk Lee, Juncheol J Clin Med Review This study aimed to determine the frequency of prophylactic steroid administration to prevent reintubation after extubation in critically ill patients. We systematically searched MEDLINE, Embase and Cochrane Library for studies regarding the preventive use of multiple doses or single-dose steroids prior to extubation on July 2020 and conducted a network meta-analysis (NMA) to compare these interventions. To assess the risk of bias of each included study, version 2 of the Cochrane risk-of-bias tool for randomized trials was used. Nine randomized control trials comprising 2098 patients with comparisons of the three interventions were included. Use of multiple doses and single doses of intravenous steroids administration showed a significantly lower rate of reintubation compared with placebo (odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.25–0.72; OR: 0.31, 95% CI: 0.14–0.69). However, the comparison between multiple doses and single doses showed no significant differences (OR: 1.22, 95% CI: 0.32–4.74). According to the surface under the cumulative ranking curve statistic, the treatments should be ranked as follows: single dose (87.1%), high dose (62.8%) and placebo (0.1%). This NMA showed that the multiple doses were not statistically superior to the single dose in lowering the incidence of reintubation after extubation in critically ill patients. Therefore, use of a single-dose steroid can reduce the incidence of reintubation. MDPI 2021-06-29 /pmc/articles/PMC8268958/ /pubmed/34209761 http://dx.doi.org/10.3390/jcm10132900 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ahn, Chiwon
Na, Min Kyun
Choi, Kyu-Sun
Lim, Tae Ho
Jang, Bo-Hyoung
Kim, Wonhee
Cho, Youngsuk
Shin, Hyungoo
Kim, Jae Guk
Lee, Juncheol
Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis
title Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis
title_full Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis
title_fullStr Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis
title_full_unstemmed Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis
title_short Comparison between Multiple Doses and Single-Dose Steroids in Preventing the Incidence of Reintubation after Extubation among Critically Ill Patients: A Network Meta-Analysis
title_sort comparison between multiple doses and single-dose steroids in preventing the incidence of reintubation after extubation among critically ill patients: a network meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268958/
https://www.ncbi.nlm.nih.gov/pubmed/34209761
http://dx.doi.org/10.3390/jcm10132900
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