Dexamethasone pretreatment for 24 h versus 6 h for prevention of postextubation airway obstruction in children: a randomized double-blind trial

Abstract

24-h pretreatment with multidose dexamethasone reduced the incidence of PEAO and the time to recover from it. 24hPD should be considered for high-risk children intubated for >48 h in the study setting. Further studies with larger sample size from different socioeconomic background are desirable to validate these findings.

Asynchronies during mechanical ventilation are associated with mortality

“…Dr Baranwal and colleagues [73] made a valuable contribution to another unknown in paediatric airway management. They asked if 24-h dexamethasone pretreatment was superior to 6-h pretreatment for prevention of postextubation airway obstruction in children?…”

Effectiveness of steroids vs placebo in preventing upper airway obstruction after extubation in critically-ill children: rationale and design of a multicentric, double-blind, randomized study.

“…Indeed, this type of edema in children affects the subglottal region more frequently than the glottal region [2,4]. Signs of airway obstruction include stridor and respiratory distress, which require reintubation in 6-13% of patients [1][2][3].…”

“…Indeed, this type of edema in children affects the subglottal region more frequently than the glottal region [2,4]. Signs of airway obstruction include stridor and respiratory distress, which require reintubation in 6-13% of patients [1][2][3].Risk factors related to post-extubation UAO include underlying respiratory or neurological disease, This study was supported by Carlos III Health Institute (Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund) as a non-commercial clinical trial (grant number EC11-077).The study medication and placebo were provided by Kern-Pharma in their primary packaging as ampoules.The investigators, patients or their families will not receive any compensation for their participation in this study.…”

Comments on Baranwal et al: Dexamethasone pretreatment for 24 h versus 6 h for prevention of postextubation airway obstruction in children

“…Dear Editor, I read with interest the paper of Baranwal et al [1] on the use of a 24-h versus a 6-h pre-extubation (pretreatment) protocol of dexamethasone (24hPD vs. 6hPD) to prevent postextubation airway obstruction (PEAO) in children in a resourcelimited pediatric intensive care unit. The primary outcome of the study was the occurrence of clinically significant PEAO, as defined by a composite indicator comprised of a modified version of Westley's croup score (mWCS) of C4, which required adrenaline nebulization treatment(s) and/or reintubation during the 48-h post-extubation period.…”