Dexamethasone in the prevention of postextubation stridor in children

• Published in: The Journal of pediatrics Vol. 118; no. 2; pp. 289 - 294
• Main Authors: Tellez, David W., Galvis, Antonio G., Storgion, Stephanie A., Amer, Harold N., Hoseyni, Mohammad, Deakers, Timothy W.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.1991; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Dexamethasone - therapeutic use; Double-Blind Method; Humans; Infant; Intensive care medicine; Intensive Care Units, Pediatric; Intubation, Intratracheal - adverse effects; Laryngeal Edema - prevention & control; Medical sciences; Prospective Studies; Respiratory Sounds - etiology; Risk Factors; Human; Prevention; Dexamethasone; Respiratory intensive care; Child; Resuscitation; Extubation
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(05)80505-0

To assess whether there is any advantage in the use of corticosteroid to prevent postextubation stridor in children, we conducted a prospective, randomized, double-blind trial of dexamethasone versus saline solution. The patients were evaluated and then randomly selected to receive either dexamethasone or saline solution according to a stratification based on risk factors for postextubation stridor: age, duration of intubation, upper airway trauma, circulatory compromise, and tracheitis. Dexamethasone, 0.5 mg/kg, was given every 6 hours for a total of six doses beginning 6 to 12 hours before and continuing after endotracheal extubation in a pediatric intensive care setting. There was no statistical difference in incidence of postextubation stridor in the two groups; 23 of 77 children in the placebo group and 16 of 76 in the dexamethasone group had stridor requiring therapy ( p=0.21). We conclude that the routine use of corticosteroids for the prevention of postextubation stridor during uncomplicated pediatric intensive care airway management is unwarranted.