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A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children
RATIONALE: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. OBJECTIVES: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Thoracic Society
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819263/ https://www.ncbi.nlm.nih.gov/pubmed/35976878 http://dx.doi.org/10.1513/AnnalsATS.202203-212OC |
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author | Iyer, Narayan P. López-Fernández, Yolanda M. González-Dambrauskas, Sebastián Baranwal, Arun K. Hotz, Justin C. Zhu, Meng Zhang, Yuan Craven, Hannah J. Whipple, Elizabeth C. Abu-Sultaneh, Samer Khemani, Robinder G. |
author_facet | Iyer, Narayan P. López-Fernández, Yolanda M. González-Dambrauskas, Sebastián Baranwal, Arun K. Hotz, Justin C. Zhu, Meng Zhang, Yuan Craven, Hannah J. Whipple, Elizabeth C. Abu-Sultaneh, Samer Khemani, Robinder G. |
author_sort | Iyer, Narayan P. |
collection | PubMed |
description | RATIONALE: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. OBJECTIVES: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. METHODS: MEDLINE, CINAHL, and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 h before extubation) and the dose (high dose: ⩾0.5 mg/kg/dose). We performed Bayesian network meta-analysis with studies grouped into four regimens: high dose, early use (HE); low dose, early use (LE); high dose, late use (HL); and low dose, late use. RESULTS: Eight trials (n = 903) were included in the analysis. For preventing UAO (odds ratio; 95% credible interval), HE (0.13; 0.04–0.36), HL (0.39; 0.19–0.74), and LE (0.15; 0.04–0.58) regimens appear to be more effective than no dexamethasone (low certainty). HE and LE had the highest probability of being the top-ranked regimens for preventing UAO (surface under the cumulative ranking curve 0.901 and 0.808, respectively). For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared with no dexamethasone (very low certainty). HE and LE were the top-ranked regimens (surface under the cumulative ranking curve 0.803 and 0.720, respectively) for preventing reintubation. Sensitivity analysis showed that regimens that started >12 hours before extubation were likely more effective than regimens started >6 hours before extubation. CONCLUSIONS: Periextubation dexamethasone can prevent postextubation UAO in children, but effectiveness is highly dependent on timing and dosing regimen. Early initiation (ideally >12 h before extubation) appears to be more important than the dose of dexamethasone. Ultimately, the specific steroid strategy should be personalized, considering the potential for adverse events associated with dexamethasone and the individual risk of UAO and reintubation. |
format | Online Article Text |
id | pubmed-9819263 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Thoracic Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-98192632023-01-09 A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children Iyer, Narayan P. López-Fernández, Yolanda M. González-Dambrauskas, Sebastián Baranwal, Arun K. Hotz, Justin C. Zhu, Meng Zhang, Yuan Craven, Hannah J. Whipple, Elizabeth C. Abu-Sultaneh, Samer Khemani, Robinder G. Ann Am Thorac Soc Systematic Reviews RATIONALE: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. OBJECTIVES: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. METHODS: MEDLINE, CINAHL, and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 h before extubation) and the dose (high dose: ⩾0.5 mg/kg/dose). We performed Bayesian network meta-analysis with studies grouped into four regimens: high dose, early use (HE); low dose, early use (LE); high dose, late use (HL); and low dose, late use. RESULTS: Eight trials (n = 903) were included in the analysis. For preventing UAO (odds ratio; 95% credible interval), HE (0.13; 0.04–0.36), HL (0.39; 0.19–0.74), and LE (0.15; 0.04–0.58) regimens appear to be more effective than no dexamethasone (low certainty). HE and LE had the highest probability of being the top-ranked regimens for preventing UAO (surface under the cumulative ranking curve 0.901 and 0.808, respectively). For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared with no dexamethasone (very low certainty). HE and LE were the top-ranked regimens (surface under the cumulative ranking curve 0.803 and 0.720, respectively) for preventing reintubation. Sensitivity analysis showed that regimens that started >12 hours before extubation were likely more effective than regimens started >6 hours before extubation. CONCLUSIONS: Periextubation dexamethasone can prevent postextubation UAO in children, but effectiveness is highly dependent on timing and dosing regimen. Early initiation (ideally >12 h before extubation) appears to be more important than the dose of dexamethasone. Ultimately, the specific steroid strategy should be personalized, considering the potential for adverse events associated with dexamethasone and the individual risk of UAO and reintubation. American Thoracic Society 2023-01-01 /pmc/articles/PMC9819263/ /pubmed/35976878 http://dx.doi.org/10.1513/AnnalsATS.202203-212OC Text en Copyright © 2023 by the American Thoracic Society https://creativecommons.org/licenses/by-nc-nd/4.0/This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . For commercial usage and reprints, please e-mail Diane Gern. |
spellingShingle | Systematic Reviews Iyer, Narayan P. López-Fernández, Yolanda M. González-Dambrauskas, Sebastián Baranwal, Arun K. Hotz, Justin C. Zhu, Meng Zhang, Yuan Craven, Hannah J. Whipple, Elizabeth C. Abu-Sultaneh, Samer Khemani, Robinder G. A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
title | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
title_full | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
title_fullStr | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
title_full_unstemmed | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
title_short | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
title_sort | network meta-analysis of dexamethasone for preventing postextubation upper airway obstruction in children |
topic | Systematic Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819263/ https://www.ncbi.nlm.nih.gov/pubmed/35976878 http://dx.doi.org/10.1513/AnnalsATS.202203-212OC |
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