L-epinephrine and dexamethasone in postextubation airway obstruction: a prospective, randomized, double-blind placebo-controlled study.
OBJECTIVE
This prospective randomized double-blind placebo-controlled study paired trial groups to investigate the effect of intravenous dexamethasone and nebulized L-epinephrine on the clinical development of postextubation laryngeal edema.


METHODS
Sixty-four patients aged 1 day to 12 years who needed intubation from August/1997 to February/1999 in the Pediatric Intensive Care Unit (PICU) of Santa Casa de São Paulo School of Medicine were paired according to age, height and weight, anthropometric z-scores, duration of tracheal intubation and number of intubation attempts. Patients received intravenous dexamethasone (0.2mg/kg every 6h), with or without nebulized L-epinephrine (0.5mg/kg every 4h) in the study groups; in the control groups, they received nebulized or intravenous isotonic saline solution, or both.


METHODS
frequency and severity of the laryngeal edema (according to Westley Clinical Scoring System), as well as the time interval (min) between extubation and the first postextubation laryngeal edema scores. Postextubation respiratory rate and transcutaneous oxygen saturation were employed as indicators of the clinical conditions for extubation.


RESULTS
Laryngeal edema frequencies did not change according to treatments, chi(2) (3, N=64)=0.58, p>0.05, and the highest scores were not reached in the 24h after extubation, chi(ranks)(2) (3, N=16)=1.03, p>0.05.


CONCLUSIONS
Dexamethasone and l-epinephrine did not reduce the clinical progression of airway obstruction due to laryngeal edema in the early postextubation period.
Cesar
Regina Grigolli
RG
Pediatric Intensive Care Unit, Department of the Santa Casa de São Paulo, School of Medicine, Lapa, CEP 05077-120 São Paulo, Brazil. reginautiped@uol.com.br
de Carvalho
Werther Brunow
WB
D000280:Administration, Inhalation; D000402:Airway Obstruction / Q000209:etiology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D007819:Laryngeal Edema / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome
D003907:Dexamethasone; D004837:Epinephrine