Comparison of High- and Low-dose Dexamethasone for Preventing Postextubation Airway Obstruction in Adults: A Prospective, Randomized, Double blind, Placebo-controlled Study

24-hour Pretreatment with Low Dose (0.25mg/Kg/dose) versus High Dose (0.5mg/Kg/dose) Dexamethasone for prevention of Post-Extubation Airway Obstruction in Children: A Randomized Open-label Non-inferiority Trial

“…Multi-dose pretreatment regime of systemic steroid starting 12-24 hours prior to planned extubation reduces PEAO in adult 6-10 as well as in pediatric 1,9 patients. Dexamethasone is preferred over other steroids 1,7,8 . Our previous study (period: 2009-10) demonstrated that 24-hour pretreatment with a high dose of dexamethasone prevents PEAO and need of reintubation 1 .…”

“…Incidence is higher in low-resource settings, as children get intubated in emergency and uncontrolled situations, have multiple airway manipulations and hypoalbuminemic edema at the time of extubation 1 . Multi-dose pretreatment with systemic steroids seems to prevent PEAO in at-risk adults [6][7][8][9][10] , as well as in children 1,5,9 . We demonstrated reduction in incidence (82% vs 65%) and severity of PEAO with 24h pretreatment with multidose dexamethasone (0.5 mg/Kg/dose; max, 8 mg/dose; q6h; total of 6 doses) compared to 6h pre-treatment in a clinical setting with high incidence of PEAO 1 .…”

A case report of serotype W135 Neisseria meningitidis epiglottitis in the United States and review of twelve adult cases of meningococcal epiglottitis

“…The authors concluded that prophylactic use in every patient is unwarranted; however, therapy may be helpful in intubated high-risk patients susceptible to airway obstruction [ 17 ]. In a study by Lin et al low-dose dexamethasone (5 mg) doses were compared to high-dose (10 mg) doses in critically ill patients with prolonged intubation and demonstrated reduction in the frequency of post-extubation airway obstruction [ 18 ]. No difference was identified between low-dose and high-dose [ 18 ].…”

“…In a study by Lin et al low-dose dexamethasone (5 mg) doses were compared to high-dose (10 mg) doses in critically ill patients with prolonged intubation and demonstrated reduction in the frequency of post-extubation airway obstruction [ 18 ]. No difference was identified between low-dose and high-dose [ 18 ]. There was not a clear role of high-dose dexamethasone therapy for epiglottitis in our case, but the patient was at risk for airway complications.…”

“…The proponents of intubation agree that sudden and lethal airway obstruction can occur and the airway should be secured [ 19 ]. The opposite argument maintains that most adults with epiglottitis do not have a jeopardized airway and sudden or complete obstruction is not common without preceding symptoms or signs of respiratory distress [ 4 , 18 ]. Predicting which patients with respiratory symptoms will progress to airway obstruction is challenging, but those with severe respiratory distress or impending arrest require immediate intubation, cricothyroidotomy, or tracheostomy in the emergency room [ 18 ].…”