title: Comparison of the efficacy of nebulized budesonide and intravenous dexamethasone administration before extubation in prevention of post-extubation complications among patients admitted in intensive care unit.
abstract: BACKGROUND
  Narrowing of the airway caused by tracheolaryngeal edema is one of the most common complications of endotracheal intubation particularly among patients requiring mechanical ventilation longer than 36 h that can cause other complications and increase mortality rate. The aim of this study was to investigate the efficacy of nebulized budesonide in comparison with intravenous (IV) dexamethasone administration before extubation in prevention of post-extubation complications.
  
  
  METHODS
  This double-blind clinical trial was carried out at the intensive care unit (ICU) of a tertiary care center (Alzahra Hospital in Isfahan). The study's population was comprised of 90 patients who had been admitted in the ICU and required intubation at least for 48 h. All patients were between 18 and 65 years of age. Having randomly divided the patients into two equal groups, the first group received nebulized budesonide while the second group was treated by IV dexamethasone 1 h before extubation. The treatment continued up to 48 h after extubation. The collected data from both groups was then subjected to statistical analyses to come to results.
  
  
  RESULTS
  There was no significant difference between the two groups; hence, both drugs were found to be effective in prophylaxis of the complications due to tracheal extubation. According to the findings of the current study, since nebulized budesonide has no systemic complications of IV corticosteroid, it can be used as the first choice in reducing the complications attributed to extubation.
  
  
  CONCLUSIONS
  Considering the very low systemic absorption of nebulized budesonide; however, we recommend it for prevention of post-extubation complications instead of IV dexamethasone.
authors.affiliation: Department of Anesthesiology and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Parviz
authors.initials: P
authors.lastname: Kashefi
authors.affiliation: Department of Anesthesiology and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Abbasi
authors.affiliation: Department of Rheumatology, Metabolic Diseases Research Center, Buo-Ali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Abbasi
authors.affiliation: Department of Cardiology, Emdadi Hospital, Zanjan University of Medical Sciences, Abhar, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Davoodi
authors.affiliation: Department of Anesthesiology and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Abbasi
keywords: Dexamethasone; extubation; intensive care unit; nebulized budesonide