Effect of nebulized budesonide in preventing postextubation complications in critically patients: A prospective, randomized, double-blind, placebo-controlled study

Abstract

Background:The efficacy of steroid administration in the prevention of postextubation complications in critical care remains controversial. The purpose of this study was to determine whether administration of nebulized budesonide in critically ill patients reduces the occurrence of postextubation airway complications.Materials and Methods:This was a prospective, randomized, double-blind, placebo-controlled study. We prospectively followed up 70 adult patients in the intensive care unit who were intubated for more than 48 h. Patients received either nebulized budesonide (1 mg every 12 h; n = 35) or placebo (normal saline; n = 35) until 48 h after extubation. Then, the postextubation complications were assessed and recorded within 48 h of extubation.Results:The incidence of respiratory distress was lower in budesonide group (8.6% vs. 31.4%, P = 0.017). Reintubation with mechanical support was necessary in 8.6% (3.35) of patients in the budesonide group and 31.4% (11.35) of patients in the placebo group (P = 0.017).Conclusion:Nebulized budesonide after extubation is effective in reducing the incidence of reintubation and respiratory distress in adult patients.

Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review

“…The large variation may be explained by the lack of a standardized method to identify LE, resulting in the use of different definitions of PLE in various studies. Similarly, the reported incidence of PES varies widely; estimated incidence ranges from 1.5 % to 26.3 % [ 1 , 14 – 29 ].…”

“…Similarly, the reported incidence of PES varies widely; estimated incidence ranges from 1.5 % to 26.3 % [ 1 , 14 – 29 ].…”

“…Furthermore, in later studies, low-risk patients were identified by the CLT and excluded from the study, resulting in a study group with a higher risk for PLE. In a recent trial, corticosteroids (budesonide) were nebulized following extubation and compared with nebulized saline, showing more than 50 % reduction in the incidence of respiratory distress and need for reintubation [ 29 ]. However, it should be noted that, although a CLT was performed, low-risk patients were not excluded on the basis of the outcome of the CLT.…”

“… 48 hours Stridor 4/40 10 % Stridor 11/40 27.5 % 0.037 Reintubation 1/40 2.5 % Reintubation 2/40 5.0 % 0.56 Cheng et al [ 26 ] b 2011 Methylprednisolone 40 mg i.v. 4 hours Stridor 6/38 15.8 % Stridor 13/33 39.4 % 0.025 Reintubation 3/38 7.9 % Reintubation 10/33 30.3 % NA Abbasi et al [ 29 ] 2014 Budesonide 4 × 1 mg nebulized 48 hours Respiratory distress 3/35 8.6 % Respiratory distress 11/35 31.4 % 0.017 Stridor 3/35 8.6 % Stridor 7/35 20 % 0.17 Reintubation 3/35 8.6 % Reintubation 11/35 31.4 % 0.017 i.v. intravenous, ns not significant, NA not applicable a Only patients with cuff leak volume (CLV) <110 ml were included.…”

“…However, it should be noted that in the most recent trial corticosteroids were started only 4 hours before extubation and a similar reduction of PLE and reintubation rate was observed [ 26 ]. Furthermore, recent data suggest that administration of nebulized corticosteroids following extubation might well be as effective as intravenously administered corticosteroids [ 29 ]. Therefore, further research is needed to identify the optimal route of administration and treatment algorithm.…”