Dexamethasone in the prevention of postextubation stridor in children.
To assess whether there is any advantage in the use of corticosteroid to prevent postextubation stridor in children, we conducted a prospective, randomized, double-blind trial of dexamethasone versus saline solution. The patients were evaluated and then randomly selected to receive either dexamethasone or saline solution according to a stratification based on risk factors for postextubation stridor: age, duration of intubation, upper airway trauma, circulatory compromise, and tracheitis. Dexamethasone, 0.5 mg/kg, was given every 6 hours for a total of six doses beginning 6 to 12 hours before and continuing after endotracheal extubation in a pediatric intensive care setting. There was no statistical difference in incidence of postextubation stridor in the two groups; 23 of 77 children in the placebo group and 16 of 76 in the dexamethasone group had stridor requiring therapy (p = 0.21). We conclude that the routine use of corticosteroids for the prevention of postextubation stridor during uncomplicated pediatric intensive care airway management is unwarranted.
Tellez
D W
DW
Division of Pediatric Intensive Care, Childrens Hospital Los Angeles, CA 90027.
Galvis
A G
AG
Storgion
S A
SA
Amer
H N
HN
Hoseyni
M
M
Deakers
T W
TW
D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007819:Laryngeal Edema / Q000517:prevention & control; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology; D012307:Risk Factors
D003907:Dexamethasone