Dexamethasone for the prevention of postextubation airway obstruction

Anene, Okechukwu; Meert, Kathleen L.; Uy, Herbert G.; Simpson, Pippa; Sarnaik, Ashok P.

doi:10.1097/00003246-199610000-00011

Cited by 128 publications

(28 citation statements)

References 10 publications

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“…The frequency of pediatric reintubation for stridor ranges from 2% to 52% 72-77 . Other variables related to stridor included the number of racemic epinephrine treatments 73,76-80 , use of a helium-oxygen gas mixture 73 , and stridor requiring some form of intervention 74,77 . Two RCTs evaluating the use of dexamethasone to prevent post-extubation stridor reported reintubation in 11% 73 and 25% 74 of patients with stridor.…”

Section: Resultsmentioning

confidence: 99%

Defining sedation-related adverse events in the pediatric intensive care unit

Grant¹,

Balas²,

Curley³

2013

Heart & Lung

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Section: Resultsmentioning

confidence: 99%

Defining sedation-related adverse events in the pediatric intensive care unit

Grant¹,

Balas²,

Curley³

2013

Heart & Lung

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“…Inconsistency in the assessment of a clinical outcome such as post extubation UAO may in part explain why few therapeutic studies on post-extubation stridor have demonstrated a benefit 2,5,13,14 . Directly meaningful outcomes for therapeutic studies, such as re-intubation secondary to UAO, are relatively rare when applied to the global PICU population (4 or 5 of the 112 extubations in our study would have met these criteria (3.6–4.5%)).…”

Section: Discussionmentioning

confidence: 99%

“…Incidence rates for post-extubation UAO range from 6–69 %, and result in reintubation 2–22% of the time 2–5 . Based on clinical grounds alone, it is estimated that up to 1/3 of all failed extubations result from UAO 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Pediatric upper airway obstruction: Interobserver variability is the road to perdition

Khemani

Schneider

Morzov

et al. 2013

Journal of Critical Care

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Purpose To determine the inter-observer variability in the clinical assessment of pediatric upper airway obstruction (UAO). To explore how variability in assessment of UAO may contribute to risk factors and incidence of post-extubation UAO. Materials Prospective trial in two tertiary care Pediatric intensive care units. Bedside practitioners performed simultaneous, blinded UAO assessments on 112 children after endotracheal extubation. Results Agreement amongst RTs, RNs and MDs was poor for cyanosis (kappa (κ) =0.01), and hypoxemia at rest (κ =0.14); and fair for consciousness (κ =0.27), air entry (κ =0.32), hypoxemia with agitation (κ =0.27), and pulsus paradoxus (κ =0.23). When looking at “stridor” and “retractions,” defined using more than 2 grades of severity from the Westley Croup Score, the inter-relater reliability was moderate (κ =0.43 and κ =0.47, respectively). This could be improved marginally by dichotomizing the presence or absence of stridor (κ =0.54) or retractions (κ =0.53). The overall incidence of UAO after extubation (stridor plus retractions) could range from 7–22%, depending on how many providers were required to agree. Conclusions Physical findings routinely used for UAO have poor inter-observer reliability amongst bedside providers. This variability may contribute to inconsistent findings regarding incidence, risk factors, and therapies for post-extubation UAO.

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“…Briefly, determination of arterial blood gases. All the children were then deeply sedated with a continuous infusion physicians of the mobile critical care units of the for the risk of mortality were found previously in a ISS similar population of injured children and Median (SD) 28 (25)(26)(27)(28)(29)(30)(31)(32)(33) determined as a PTS < 4, a GCS < 7 and an ISS > 25.…”

Section: Methodsmentioning

confidence: 99%

Complications of emergency tracheal intubation in severely head‐injured children

Meyer

Orliaguet

Blanot

et al. 2000

Pediatric Anesthesia

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A high incidence of unsuccessful attempts and complications has been reported when emergency tracheal intubation (ETI) is performed outside the hospital in severely injured children. The aim of this prospective series was to analyse the incidence and related risk factors of complications of emergency tracheal intubation. The time to complete successful ETI and occurrence of incidents, e.g. cough reflex, hypoxia or spasm were related to the experience of the physician performing intubation and the use of drugs to facilitate ETI. The incidence of hypoxia, hypercarbia, postintubation complications such as extubation stridor and long-term sequelae were noted. Of the 188 children, 78% were successfully intubated at the site of the accident, 10% upon arrival at a local hospital from where they were secondarily transferred and 12% upon admission to our trauma centre. The most severely injured children were intubated in the field in 98% of cases without failure, nor life-threatening complications related to ETI. The experience of the operator influenced the number of attempts and the time to complete successful intubation. Immediate incidents were noted in 25% of children, e.g. cough in 18%. The regimen of drugs, but not level of consciousness, influenced the incidence of immediate incidents; without drugs, more than 67% experienced incidents. Early tracheal intubation and controlled ventilation resulted in adequate ventilation upon arrival (mean PaO2 of 35.8+/-24 kPa, mean PaCO2 of 4.35+/-1 kPa). Long-term complications, including transient stridor upon extubation in 33% of the cases, and laryngeal granuloma or tracheal stenosis, were comparable to those in other series. ETI in shocked patients and pulmonary infection in hospital, but not the technique of ETI, increased the risks of long-term complications. Emergency tracheal intubation can be performed safely in the field, and results in adequate ventilation during transportation of severely injured children, provided that it can be performed by trained physicians using adequate drugs to facilitate intubation.

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Dexamethasone for the prevention of postextubation airway obstruction

Abstract: Pretreatment with dexamethasone decreases the frequency of postextubation airway obstruction in children.

Cited by 128 publications

References 10 publications

Defining sedation-related adverse events in the pediatric intensive care unit

Defining sedation-related adverse events in the pediatric intensive care unit

Pediatric upper airway obstruction: Interobserver variability is the road to perdition

Complications of emergency tracheal intubation in severely head‐injured children

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