title: Dexamethasone pretreatment for 24 h versus 6 h for prevention of postextubation airway obstruction in children: a randomized double-blind trial.
abstract: OBJECTIVE
  Multidose steroid pretreatment is effective in preventing postextubation airway obstruction (PEAO) in adults, however controversy continues for children. This study was designed as a randomized, placebo-controlled, double-blind trial to compare the effect of 24-h pretreatment with dexamethasone (24hPD) versus 6-h pretreatment (6hPD) on PEAO and reintubation in children at a tertiary care hospital in a developing economy.
  
  
  METHODS
  Hundred twenty-four children (3 months to 12 years) intubated for ≥48 h and planned to have extubation during next 24 h were randomized to receive 24hPD (0.5 mg/kg/dose, q6h, total of six doses; n = 66) or 6hPD (total of three doses; n = 58). Patients with preexistent upper airway conditions, chronic respiratory diseases, steroid therapy in last 7 days, gastrointestinal bleeding, hypertension, and hyperglycemia and those likely to have poor airway reflexes were excluded.
  
  
  RESULTS
  The two groups were similar at baseline. 24hPD reduced the incidence of PEAO (43/66 versus 48/58; p = 0.027) with absolute risk reduction of 17 %. It also reduced the incidence of reintubation, though nonsignificantly, by half [5/61 versus 9/58; relative risk (RR), 1.09; 95 % confidence interval (CI), 0.96-1.25]. Time to recovery from PEAO among non-reintubated patients was shorter among 24hPD patients (p = 0.016). No adverse event was noted with dexamethasone use. Intubation duration >7 days and cuffed tracheal tubes were found to be independent risk factors for PEAO (odds ratio 6 and 3.12, respectively).
  
  
  CONCLUSIONS
  24-h pretreatment with multidose dexamethasone reduced the incidence of PEAO and the time to recover from it. 24hPD should be considered for high-risk children intubated for >48 h in the study setting. Further studies with larger sample size from different socioeconomic background are desirable to validate these findings.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, Patna, 801505, India, baranwal1970@gmail.com.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Baranwal
authors.forename: Jagdish P
authors.initials: JP
authors.lastname: Meena
authors.forename: Sunit C
authors.initials: SC
authors.lastname: Singhi
authors.forename: Jayashree
authors.initials: J
authors.lastname: Muralidharan
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects; D000402:Airway Obstruction / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011292:Premedication
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone