title: Methylprednisolone reduces the rates of postextubation stridor and reintubation associated with attenuated cytokine responses in critically ill patients.
abstract: BACKGROUND
  Treatment with corticosteroids can reduce the incidence of postextubation stridor (PES) and reintubation in critically ill adult patients, but the mechanisms remain unknown.
  
  
  METHODS
  A randomized, controlled clinical trial was conducted in an adult medical and surgical Intensive Care Unit (ICU) of a teaching hospital. Seventy-one patients who had a cuff leak percentage <24% of tidal volume received either a bolus injection of methylprednisolone at 40 mg (treated group, n=38) or normal saline (placebo group, n=33) 4 h prior to a planned extubation. The cuff leak percentage was re-assessed 1 h and 4 h post-injection. Eighty patients who had a cuff leak percentage ≥ 24% served as a control group. Plasma concentrations of multiple cytokines and C-reactive protein (CRP) were measured at baseline, 4 h and 24 h after the intervention.
  
  
  RESULTS
  The incidences of PES (15.8% vs. 39.4%, P<0.05) and reintubation rate (7.9% vs. 30.3%, P<0.05) were lower in the treated group compared to the placebo group. The plasma concentrations of IL-4 and IL-10 increased while the levels of IL-6 and IL-8 decreased at 24 h in the treated group compared to the placebo group. No difference in CRP levels was observed between the treated and placebo groups.
  
  
  CONCLUSIONS
  A single injection of methylprednisolone at the dose used 4 h prior to planned extubation effectively reduced the incidence of PES and the reintubation rate. These beneficial effects were associated with the up-regulation of IL-4 and IL-10 and the down-regulation of IL-6 and IL-8 in the critically ill adult patients.
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: K C
authors.initials: KC
authors.lastname: Cheng
authors.forename: C M
authors.initials: CM
authors.lastname: Chen
authors.forename: C K
authors.initials: CK
authors.lastname: Tan
authors.forename: H M
authors.initials: HM
authors.lastname: Chen
authors.forename: C L
authors.initials: CL
authors.lastname: Lu
authors.forename: H
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D016638:Critical Illness; D016207:Cytokines / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D012121:Respiration, Artificial; D012135:Respiratory Sounds / Q000187:drug effects* / Q000209:etiology*; D015300:Ventilator Weaning
chemical_list: D000893:Anti-Inflammatory Agents; D016207:Cytokines; D002097:C-Reactive Protein; D008775:Methylprednisolone