Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone.
OBJECTIVE
To evaluate the risk factors for postextubation laryngeal stridor and its prevention by hydrocortisone in adult patients.


METHODS
Prospective, randomized, double-blind, placebo controlled study.


METHODS
Medical and surgical ICU of a tertiary teaching hospital.


METHODS
77 consecutive patients of both sexes, who had undergone tracheal intubation for more than 24 h and fulfilled the weaning criteria, were eligible for the study. Patients were excluded if they were less than 15 years of age, had a disease or the surgery of the throat, or had been extubated during the current hospitalization.


METHODS
The control group received placebo (normal saline 3 cc) and the experimental group received hydrocortisone 100 mg by intravenous infusion 60 min before extubation.


METHODS
Patients were observed 24 h after extubation for symptoms or signs of laryngeal edema or stridor: prolonged inspiration with accessory usage of respiratory muscles or crowing sound with inspiration or reintubation.


RESULTS
The overall incidence of postextubation stridor was 22% (17/77). Only one patient (1%), who belonged to the control group, needed reintubation. 39% of female patients and 17% of male patients developed stridor. The relative risk of females developing this complication was 2.29. 7/39 of the hydrocortisone group and 10/38 of patients in the control group developed postextubation stridor.


CONCLUSIONS
Hydrocortisone did not significantly reduce the incidence of postextubation laryngeal edema or stridor. From the risk factors evaluated, we were unable to demonstrate a statistical correlation between postextubation stidor and the duration of the intubation, the patient's age, the internal diameter of the endotracheal tube, or the route of intubation. However, female patients were more likely to develop this complication.
Department of Respiratory Therapy, Veterans General Hospital-Taipei, Taiwan, R.O.C.
L I
LI
Ho
H J
HJ
Harn
T C
TC
Lien
P Y
PY
Hu
J H
JH
Wang
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007819:Laryngeal Edema / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011292:Premedication; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone