Do Corticosteroids Prevent Postextubation Laryngeal Edema? Prospective Study of 276 Adults

Gaussorgues, P.; Boyer, F.; Piperno, D.; Gerard, Michèle; Léger, P; Robert, Dominique

doi:10.1097/00003246-198806000-00021

Cited by 12 publications

(9 citation statements)

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“…Early animal studies showed that administration of steroids reduces laryngeal edema and can prevent post-extubation laryngeal edema [39,40]. Corticosteroid administration before extubation is part of the extubation protocol in some centers [4,7,41]. Steroid use for 24 hours is considered safe, and no major adverse effects related to its use have been reported in a number of studies [3,6,13,16,32,42,43].…”

Section: Preventionmentioning

confidence: 99%

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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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Section: Preventionmentioning

confidence: 99%

“…All of these studies failed to show a significant effect on laryngeal edema, PES and reintubation rates [4,7,41]. In contrast, a single dose of 40 mg methylprednisolone 24 hours before extubation was effective in lowering the incidence of PES and the reintubation rate in a randomized controlled trial by Cheng and colleagues [3].…”

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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“…5,9 For example, while the incidence of PELE in the placebo arm ranged from 1.4% to 23% in the early studies, it averaged greater than 22% in each of the later investigations. 5-9, 20 One of the newer studies has been criticized because the cuff-leak test was not used to identify patients at high risk for PELE. 7 However, given the 22% incidence of PELE seen in this trial, it is suggested that this study cohort was in fact a population at high risk for PELE.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroids for Prevention of Postextubation Laryngeal Edema in Adults

2008

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Data from the most recent well-designed clinical trials suggest that prophylactic corticosteroid therapy can reduce the incidence of PELE and the subsequent need for reintubation in mechanically ventilated patients at high-risk for PELE. Based on this information, clinicians should consider initiating prophylactic corticosteroid therapy in this population. Further studies are needed to establish the optimal dosing regimens as well as the subgroups of patients at high risk for PELE who will derive the greatest benefit from this preventive steroid therapy.

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“…The administration of a single dose 1 h before planned extubation is not effective [93,94]. On the contrary, several single doses beginning 12-24 h before extubation reduce the incidence of a post-extubation stridor [95,96].…”

Section: Measures After Securing the Airwaymentioning

confidence: 98%