title: Nebulized Fluticasone for Preventing Postextubation Stridor in Intubated Children: A Randomized, Double-Blind Placebo-Controlled Trial.
abstract: OBJECTIVE
  To evaluate the efficacy of nebulized fluticasone propionate in the prevention of postextubation stridor in children.
  
  
  METHODS
  Double-blind, placebo-controlled randomized clinical trial.
  
  
  METHODS
  PICU in a tertiary referral center.
  
  
  METHODS
  Children 1 month to 15 years old who underwent mechanical ventilation.
  
  
  METHODS
  Patients were randomly assigned into two groups after stratification based on age group receiving nebulized fluticasone 1,000 µg or normal saline solution, immediately after extubation. Vital signs and modified Westley score were evaluated for 6 hours after extubation. The primary outcome was the prevalence of postextubation stridor.
  
  
  RESULTS
  One hundred forty-seven intubated children were enrolled into this study. Baseline characteristics between two groups were not different. There was no significant difference in the incidence of postextubation stridor (12/74 [16%] vs 13/73 [18%]; p = 0.797). However, when analyzing the subgroup of emergently intubated children, the fluticasone group had a longer delay median time for the initiation of noninvasive ventilation than the control group (380 [90-585] vs 60 [42-116] min; p = 0.044). The modified Westley scores at 30 and 60 minutes in the control group were significantly higher than the fluticasone group (4 vs 2, p = 0.04; 4.5 vs 0.5, p = 0.02, respectively).
  
  
  CONCLUSIONS
  The single dose of 1,000-µg nebulized fluticasone did not decrease the prevalence of postextubation stridor. However, it might be beneficial in emergently intubated children.
authors.affiliation: 1Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 2Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pharsai
authors.initials: P
authors.lastname: Prasertsan
authors.forename: Duangjai
authors.initials: D
authors.lastname: Nakju
authors.forename: Rojjanee
authors.initials: R
authors.lastname: Lertbunrian
authors.forename: Marut
authors.initials: M
authors.lastname: Chantra
authors.forename: Nattachai
authors.initials: N
authors.lastname: Anantasit
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D060666:Airway Extubation / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D000068298:Fluticasone / Q000494:pharmacology / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012135:Respiratory Sounds / Q000187:drug effects* / Q000209:etiology; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000068298:Fluticasone