title: Post-extubation stridor in Respiratory Syncytial Virus bronchiolitis: Is there a role for prophylactic dexamethasone?
abstract: OBJECTIVE
  The purpose of this study was to determine the incidence of reintubation due to upper airway obstruction in a homogeneous group of ventilated infants with Respiratory Syncytial Virus bronchiolitis. Our secondary objective was to determine whether prophylactic administration of dexamethasone prior to extubation was associated with decreased risk of reintubation.
  
  
  METHODS
  This retrospective observational study in two Pediatric Intensive Care Units in 2 university hospitals in The Netherlands included two hundred patients younger than 13 months admitted with respiratory insufficiency caused by Respiratory Syncytial Virus bronchiolitis, requiring invasive mechanical ventilation. A logistic regression analysis with propensity score method was used to adjust for possible confounding.
  
  
  RESULTS
  Reintubation due to post-extubation stridor occurred in 17 (8.5%) of 200 patients. After propensity score matching, administration of dexamethasone prior to extubation was associated with a significantly (p = 0.0011) decreased risk of reintubation due to post-extubation stridor compared to patients not receiving prophylactic dexamethasone (absolute risk reduction 13%, 95% CI 5.3-21%).
  
  
  CONCLUSIONS
  Reintubation due to post-extubation stridor is an important complication of ventilation for Respiratory Syncytial Virus bronchiolitis. Dexamethasone administered prior to extubation probably reduces the risk of post-extubation stridor necessitating reintubation in these infants. The results of this study support initiation of a placebo-controlled trial to confirm the beneficial effect of prophylactic dexamethasone.
authors.affiliation: Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Esther S
authors.initials: ES
authors.lastname: Veldhoen
authors.affiliation: Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Smulders
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
authors.forename: Teus H
authors.initials: TH
authors.lastname: Kappen
authors.affiliation: Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Job C
authors.initials: JC
authors.lastname: Calis
authors.affiliation: Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van Woensel
authors.affiliation: Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Paulien A M
authors.initials: PA
authors.lastname: Raymakers-Janssen
authors.affiliation: Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Bont
authors.affiliation: Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Marije P
authors.initials: MP
authors.lastname: Hennus
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001988:Bronchiolitis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012120:Respiration Disorders / Q000188:drug therapy* / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects*; D012135:Respiratory Sounds / Q000187:drug effects* / Q000209:etiology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone