Dexamethasone in Prevention of Postextubation Stridor in Ventilated Children: A Randomized, Double-blinded, Placebo-controlled Trial

Operational Definitions Related to Pediatric Ventilator Liberation

“…The articles that were used to inform the definitions are cited in Table 2 . 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 During the final voting round, the expert panel agreed on all modified definitions ( e-Table 7 ). Final definitions are shown in Table 2 and reported below.…”

“… Conventional oxygen therapy is defined as the provision of > 0.21 oxygen by any of the following devices applied to a spontaneously breathing patient regardless of presence of humidification: Face mask oxygen delivered via any type of nonocclusive mask Nasal cannula at flow rates less than HFNC rates (see Definition 5) Tracheostomy collar without positive pressure B. Liberation from invasive MV 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 53 : A patient is considered to be liberated from invasive MV when: ETT: An ETT is removed and is not re-inserted within 48 h.∗ Tracheostomy tube: Positive pressure ventilation is no longer being delivered through a tracheostomy tube and is not re-initiated within 48 h.∗ This includes application of controlled, assisted, supported, or CPAP modes of positive pressure via a tracheostomy tube for any period during the day/night. ∗Excluding use for temporary procedures ...…”

The role of local inflammation in complications associated with intubation in pediatric patients: A narrative review

“…41 Dexamethasone has significant and long-lasting antiinflammatory properties; its recommended pediatric dose for airway edema is 0.15-0.5 mg/kg/dose. 42 This benefit has been shown in different studies, including a retrospective study done by Lukkassen et al which concluded that there was a significant impact on the reduction of postextubation stridor and reintubation in a group of patients between the ages of 4 weeks and 6 years. 43 Other studies, such as a double-blind randomized trial by Baranwal et al, demonstrated that a multidose dexamethasone pretreatment carried out 24 h in advance of intubation results in considerable reduction in the incidence of postintubation airway obstruction.…”

“…Dexamethasone has significant and long‐lasting anti‐inflammatory properties; its recommended pediatric dose for airway edema is 0.15–0.5 mg/kg/dose 42 . This benefit has been shown in different studies, including a retrospective study done by Lukkassen et al which concluded that there was a significant impact on the reduction of postextubation stridor and reintubation in a group of patients between the ages of 4 weeks and 6 years 43 .…”

“…Corticosteroids Both IV and topical ETT coatings have shown to reduce airway edema and inflammation and reduce the incidence of postextubation airway stridor and sore throat. [42][43][44][45][46][47] Benzydamine hydrochloride gel Has shown variable results, with benzydamine hydrochloride gel ETT coating shown to be effective in decreasing postoperative sore throat severity, 49 but showing no reduction when applied as a spray. 50 Possible future therapies Ketamine Ketamine gargles demonstrated a significant decrease in postoperative sore throat.…”