Corticosteroids for Prevention of Postextubation Laryngeal Edema in                     Adults

Roberts, Russel J.; Welch, Shannon M; Devlin, John W.

doi:10.1345/aph.1k655

Cited by 31 publications

(18 citation statements)

References 23 publications

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“…22 Previous published systematic reviews focusing on the preventive and therapeutic effect of steroids in different age groups showed no clear benefit on the occurrence of airway complications in adults, but our updated results do show such a benefit. [4][5][6] A recent meta-analysis 10 found no clear effect of steroids on preventing laryngeal oedema after extubation and reintubation in adults.…”

Section: Strengths and Limitationsmentioning

confidence: 43%

“…Administration of steroids before selected extubation is assumed to protect against or treat mucosal oedema in the glottic region caused by pressure or irritation from the endotracheal tube. Roberts et al compared trials published after 2000 with older studies 22 and suggested that the lack of clinical benefit observed with earlier studies might have resulted from lower total steroid doses. These authors also pointed out that older studies generally used only a single dose of steroids and suggested that this, compared with the longer duration of treatment in newer studies, might account for the different conclusions.…”

Section: Researchmentioning

confidence: 99%

See 1 more Smart Citation

Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

Fan

Wang

Mao

et al. 2008

BMJ

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Objective To determine whether steroids are effective in preventing laryngeal oedema after extubation and reducing the need for subsequent reintubation in critically ill adults.Design Meta-analysis.Data sources PubMed, Cochrane Controlled Trials Register, Web of Science, and Embase with no limitation on language, study year, or publication status.Selection criteria Randomised placebo controlled trials in which parenteral steroids were compared with placebo for preventing complications after extubation in adults.Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality, independently performed in duplicate. Odds ratios with 95% confidence intervals, risk difference, and number needed to treat were calculated and pooled.Main outcome measures Primary outcome: laryngeal oedema after extubation. Secondary outcome: subsequent reintubation because of laryngeal oedema. Results Six trials (n=1923) were identified. Compared with placebo, steroids given before planned extubation decreased the odds ratio for laryngeal oedema (0.38, 95% confidence interval 0.17 to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58), corresponding with a risk difference of −0.10 (−0.12 to −0.07; number needed to treat 10) and −0.02 (−0.04 to −0.01; 50), respectively. Subgroup analyses indicated that a multidose regimen of steroids had marked positive effects on the occurrence of laryngeal oedema (0.14; 0.08 to 0.23) and on the rate of subsequent reintubation (0.19; 0.07 to 0.50), with a risk difference of −0.19 (−0.24 to −0.15; 5) and −0.04 (−0.07 to −0.02; 25). In single doses there was only a trend towards benefit, with the confidence interval including 1. Side effects related to steroids were not found. Conclusion Prophylactic administration of steroids in multidose regimens before planned extubation reduces the incidence of laryngeal oedema after extubation and the consequent reintubation rate in adults, with few adverse events.

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Section: Strengths and Limitationsmentioning

confidence: 43%

Section: Researchmentioning

confidence: 99%

Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

Fan

Wang

Mao

et al. 2008

BMJ

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“…Fan and colleagues calculated a risk reduction of 0.19 (-0.24 to -0.15; number needed to treat, 5) on the occurrence of laryngeal edema and of 0.04 (-0.07 to -0.02; number needed to treat, 25) on the rate of reintubation [16]. On the contrary, the effect of a single-dose regimen used in older studies was not statistically significant in two meta-analyses [16,44]. The benefit from steroids will be greater in patients at risk for laryngeal edema, who could be identified with a positive cuff leak test [42].…”

Section: Preventionmentioning

confidence: 99%

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

et al. 2009

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Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids, epinephrine nebulization and inhalation of a helium/oxygen mixture are potentially effective, although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality.

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“…We believe it would be wise to monitor such patients on an ICU for at least 2 days. Regular intravenous steroids until tracheal tube removal could substantially reduce the incidence of post-extubation laryngeal oedema and the need for re-intubation in ICU patients ventilated for more than 36 hours [8,9].…”

Section: Discussionmentioning

confidence: 99%

Near‐fatal trial of extubation after anterior cervical spine surgery

Ginz¹,

Engel²,

Zimmerer³

2016

Anaesthesia Cases

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We report a case of a patient who suffered a near-fatal tracheal extubation following anterior cervical spine surgery. Dislocated surgical material had compromised his airway in such a manner that subsequent tracheal re-intubation was unsuccessful. Only bag/valve/mask ventilation and emergency tracheostomy saved his life. Although clinical symptoms indicated the possibility of post-extubation problems, tracheal extubation was still performed. Hypersalivation should be regarded as an early sign of oesophageal and/or airway compromise, and should not be dismissed. Before attempting extubation, these patients should undergo laryngoscopy and radiograph of the cervical spine or computerised tomography (CT) scan to exclude oedema and surgical material dislocation.

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Corticosteroids for Prevention of Postextubation Laryngeal Edema in Adults

Cited by 31 publications

References 23 publications

Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

Near‐fatal trial of extubation after anterior cervical spine surgery

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