Trials of corticosteroids to prevent postextubation airway complications.
We identified three randomized controlled trials (RCTs) that addressed whether preextubation steroid administration reduces postextubation complications in children. The pooled analysis of primary extubation in children demonstrated significantly less stridor (relative risk [RR], 0.57; 95% confidence interval [CI], 0.40 to 0.81) and a trend toward less reintubation (RR, 0.50; 95% CI, 0.02 to 13.87) with corticosteroids. One non-RCT in children who had failed extubation the first time found a significant reduction in duration of prolonged reintubation (> or = 6 days) and in failed reextubations. The four RCTs in adults reported very low reintubation rates, and no conclusions can be drawn. Only one RCT assessed postextubation stridor and found little difference. Overall, we found that corticosteroids decreased the risk of postextubation stridor in children by about 40%. However, the effect of corticosteroids in children and adults to reduce postextubation complications such as reintubation is uncertain.
Meade
M O
MO
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Guyatt
G H
GH
Cook
D J
DJ
Sinuff
T
T
Butler
R
R
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007442:Intubation, Intratracheal; D007819:Laryngeal Edema / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D012135:Respiratory Sounds; D013256:Steroids; D015300:Ventilator Weaning
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D013256:Steroids