Corticosteroids to prevent extubation failure: a systematic review and meta-analysis.
OBJECTIVE
To determine whether corticosteroids reduce the rate of extubation failure in intensive care patients of all age groups.


METHODS
Medline, EMBASE, the Cochrane Central Register of Controlled Trials, bibliographies of relevant articles, selected conference abstracts and unpublished trial databases were searched. Randomised clinical trials (RCTs) evaluating corticosteroids for the purpose of preventing extubation failure in mechanically ventilated, critically ill patients of all ages were included. Two authors independently assessed the validity of included studies and extracted data regarding characteristics of the studies and the rates of reintubation and manifestations of laryngeal oedema.


RESULTS
Fourteen RCTs including 2,600 participants were included. The mean duration of ventilation prior to attempted extubation ranged from 3 to 21 days. There was a reduction in reintubation with the use of corticosteroids, with a pooled odds ratio (OR) of 0.56 (95% CI; 0.41-0.77, P < 0.0005). The effect of corticosteroids tended to be more pronounced in studies when used at least 12 h prior to attempted extubation (OR 0.41, 95% CI; 0.26-0.64). The results were consistent across neonatal, paediatric and adult populations. There was also a reduction in laryngeal oedema in participants receiving corticosteroids, with a pooled OR of 0.36 (95% CI 0.27-0.49, P < 0.0005).


CONCLUSIONS
Corticosteroids reduce laryngeal oedema and importantly reduce the incidence of extubation failure in critically ill patients of all ages.
Intensive Care Unit, Royal North Shore Hospital, Pacific Highway, St. Leonards, Sydney, NSW 2065, Australia.
John
J
McCaffrey
Clare
C
Farrell
Paul
P
Whiting
Arina
A
Dan
Sean M
SM
Bagshaw
Anthony P
AP
Delaney
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D003422:Critical Care; D006801:Humans; D019990:Perioperative Care; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D019233:Retreatment; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones