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(Chest. 2001;120:464S-468S.)
© 2001 American College of Chest Physicians

Trials of Corticosteroids to Prevent Postextubation Airway Complications*

Maureen O. Meade, MD; Gordon H. Guyatt, MD; Deborah J. Cook, MD; T. Sinuff, MD and R. Butler, MD

* From the Departments of Medicine (Drs. Meade, Guyatt, Cook, and Sinuff), McMaster University, Hamilton, Ontario, Canada; and the Department of Anesthesia (Dr. Butler), University of Western Ontario, London, Ontario, Canada.

Correspondence to: Deborah J. Cook, MD, McMaster University, Faculty of Health Sciences Center, Department of Clinical Epidemiology, 1200 Main St West, Hamilton, Ontario, Canada: e-mail: debcook{at}mcmaster.ca

We identified three randomized controlled trials (RCTs) that addressed whether preextubation steroid administration reduces postextubation complications in children. The pooled analysis of primary extubation in children demonstrated significantly less stridor (relative risk [RR], 0.57; 95% confidence interval [CI], 0.40 to 0.81) and a trend toward less reintubation (RR, 0.50; 95% CI, 0.02 to 13.87) with corticosteroids. One non-RCT in children who had failed extubation the first time found a significant reduction in duration of prolonged reintubation (>= 6 days) and in failed reextubations. The four RCTs in adults reported very low reintubation rates, and no conclusions can be drawn. Only one RCT assessed postextubation stridor and found little difference. Overall, we found that corticosteroids decreased the risk of postextubation stridor in children by about 40%. However, the effect of corticosteroids in children and adults to reduce postextubation complications such as reintubation is uncertain.

Key Words: corticosteroids • extubation • mechanical ventilation • meta-analysis • reintubation • stridor • systematic reviews • weaning




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