Postextubation airway obstruction in children: Are steroids the key to prevention?The unanticipated need for reintubation in the pediatric intensive care unit (PICU) is associated with significant increases in morbidity, mortality, and cost of care. 1 While patients may require reintubation for a multitude of reasons, postextubation airway obstruction (PEAO) secondary to laryngeal edema is one that may be both predictable and modifiable. 2 Laryngeal edema can occur from pressure or irritation by an endotracheal tube resulting in stridor or obstruction after extubation. 1 While this complication occurs in all PICUs, the incidence is highest in low-and middle-income countries due to the presence of unique risk factors. These risk factors include AUTHOR CONTRIBUTIONS Kaitlin Verdone: Conceptualization (equal); writing original draft (lead); writing review and editing (equal). Christopher M. Watson: Conceptualization (equal); writing review and editing (equal).

Reintubation in the pediatric intensive care unit (PICU) increases morbidity, mortality, and the overall cost of care. Post-extubation airway obstruction (PEAO) is a potentially predictable cause of extubation failure and may be prevented by the use of corticosteroids. Defining which patients are most at risk for the development of POAE as well as the optimal dose and timing of corticosteroids for prevention is critical. We review the current literature regarding the use of corticosteroids surrounding extubation in the PICU and discuss the implications that a clear algorithm for identification and treatment of these patients would have in the care of critically ill children.