Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults

Kuriyama, Akira; Umakoshi, Noriyuki; Sun, Renhua

doi:10.1016/j.chest.2017.02.017

Cited by 83 publications

(82 citation statements)

References 26 publications

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“…36,37,[39][40][41]44,[46][47][48][49][50]54,56,60,[62][63][64][65][66][67][68][69]72 Topical application of ketamine was associated with decreased incidence of moderate or severe postoperative sore throat compared to non-analgesic methods (20/959 vs 146/912; RR, 0.18; 95% CI, 0.12-0.28; P < .001; I 2 = 0.0%; Figure 3). The number needed to prevent moderate or severe postoperative sore throat was 9 (95% CI, [6][7][8][9][10][11][12][13][14][15][16][17]. There was no evidence of publication bias (P = .53) ( Figure S3).…”

Section: Moderate or Severe Postoperative Sore Throatmentioning

confidence: 99%

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

Kuriyama

Nakanishi

Kamei

et al. 2020

Acta Anaesthesiol Scand

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Background Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N‐methyl‐d‐aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat. Methods We searched MEDLINE, EMBASE, and CENTRAL through September 23, 2019 for randomized controlled trials in which at least one intervention was topical ketamine to prevent postoperative sore throat in adults undergoing endotracheal intubation. The primary outcome was the incidence of sore throat at 24 hours postoperatively. The comparators were non‐analgesic controls (placebo, no treatment, or usual care) or active agents. We pooled the data using a random‐effects model. Results We included 41 randomized controlled trials involving 3784 participants. Topical ketamine was associated with reduced incidence of sore throat at 24 hours postoperatively compared to non‐analgesic methods (risk ratio, 0.45; 95% CI, 0.37‐0.54; P < .001). We found significant publication bias, but the results remained unchanged with a trim‐and‐fill analysis. Trial sequential analysis (TSA) suggested that the efficacy of topical ketamine was adequate (TSA‐adjusted 95% CI, 0.33‐0.56). The GRADE quality for this evidence was moderate. Topical ketamine was inferior to a combination of nebulized ketamine and clonidine in preventing postoperative sore throat. Conclusions Preoperative, topical ketamine application may be more effective than non‐analgesic methods in preventing postoperative sore throat. The number of studies did not suffice to determine the place of topical ketamine among agents to prevent postoperative sore throat.

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Section: Moderate or Severe Postoperative Sore Throatmentioning

confidence: 99%

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

Kuriyama

Nakanishi

Kamei

et al. 2020

Acta Anaesthesiol Scand

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“…Steroids are one of the most widely used therapies for post-extubation UAO, as they have antiinflammatory effects, thereby reducing the risk for laryngeal edema and airway obstruction. A range of steroids such as hydrocortisone, methylprednisolone and dexamethasone have been used for the prevention and management of post-extubation UAO [4,7]. Contradictory results have been obtained in studies assessing the effectiveness of steroids in preventing post-extubation UAO [5][6][7][8][9][10].…”

mentioning

confidence: 99%

“…A recent meta-analysis [7] of studies in adult patients with and without UAO risk factors receiving different regimens of steroids showed that steroids reduce the incidence of upper airway complications and reintubation in high-risk patients.…”

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confidence: 99%

“…Studies in pediatric patients are based on widely heterogeneous samples of patients, doses and timing of prophylactic therapy ranging from one hour to 24 hours prior to extubation [4,7].…”

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confidence: 99%

“…It is important that the study sample is composed of the patients who are more likely to benefit from steroids, as their use involves certain side effects such as hyperglycemia, hypertension, infection and digestive bleeding [4,7].…”

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confidence: 99%

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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.

Manrique

Laiseca

González

et al. 2019

Preprint

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Background Post-extubation upper airway obstruction (UAO) is a frequent complication causing stridor and respiratory distress, which occasionally may require reintubation, thereby increasing morbidity and mortality rates. Contradictory results have been obtained in studies assessing the effectiveness of steroids in preventing post-extubation UAO, and the available evidence is limited. We designed a multicentric randomized, placebo-controlled study to explore the effectiveness of dexamethasone in preventing post-extubation UAO in children. Methods A multicentric, prospective, double-blind, randomized, placebo-controlled, phase IV clinical trial has been designed. The sample will include pediatric patients between 1 month and 16 years of age who have been intubated for more than 48 hours. Patients with airway disorders or who have received steroids within the last seven days will be excluded. Patients will be randomized to receive either placebo or a therapy with dexamethasone 0.25 mg/kg every 6 hours to be started 6-to-12 hours prior to extubation, to a total of four doses.Randomization will be performed at a 1:1 ratio. Follow-up of patients will be carried out for 48 h after extubation. The main objective of this study is to assess the reduction of UAO symptoms following extubation, as measured using the Taussig scale. Secondary objectives include assessing the decrease in the incidence of reintubation, evaluating the use of additional therapies for upper airway obstruction, and monitoring dexamethasone potential side effects. Discussion The results of this study will contribute to the existing evidence on prophylaxis for post-extubation airway obstruction. BackgroundCritically-ill pediatric patients frequently require endotracheal intubation. Post-extubation upper airway obstruction (UAO) is a common complication that affects up to a third of patients who requireLaryngeal edema is more frequent and severe in children than in adults due to the small diameter of their airways. 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. Authors' contributionsJLH conceived the study, participated in the study design and revised the manuscript.RGC participated in the study design, revised the manuscript and is responsible for data collection.GM and LBL drafted the manuscript and are responsible for data c...

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Twenty‐four‐hour pretreatment with low dose (0.25 mg/kg/dose) versus high dose (0.5 mg/kg/dose) dexamethasone in reducing the risk of postextubation airway obstruction in children: A randomized open‐label noninferiority trial

Parajuli

Baranwal

Kumar‐M

et al. 2021

Pediatric Pulmonology

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Objective: Multidose dexamethasone pretreatment reduces risk of postextubation airway obstruction (PEAO). However, its optimal dose is not known. We planned to compare 24 h pretreatment with low-dose dexamethasone (LDD) (0.25 mg/kg/dose) versus high-dose dexamethasone (HDD) (0.5 mg/kg/dose) in reducing risk of PEAO.Design: Stratified (for age and intubation duration) randomized open-label noninferiority trial.Setting: Fifteen-bed pediatric intensive care unit in a lower-middle-income country.Patients: Children (3 months-12 years) intubated for more than or equal to 48 h and planned for first extubation . Upper airway conditions, chronic respiratory diseases, chronic NSAID therapy, steroid, or intravenous immunoglobulin in the last 7 days, presence of gastrointestinal bleeding, hypertension, and hyperglycemia were exclusions.Interventions: LDD (n = 144) or HDD (n = 143) (q6h) for a total of six doses.

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Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults

Cited by 83 publications

References 26 publications

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta‐analysis

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.

Twenty‐four‐hour pretreatment with low dose (0.25 mg/kg/dose) versus high dose (0.5 mg/kg/dose) dexamethasone in reducing the risk of postextubation airway obstruction in children: A randomized open‐label noninferiority trial

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