Corticosteroids to prevent extubation failure: a systematic review and meta-analysis
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To determine whether corticosteroids reduce the rate of extubation failure in intensive care patients of all age groups.
Medline, EMBASE, the Cochrane Central Register of Controlled Trials, bibliographies of relevant articles, selected conference abstracts and unpublished trial databases were searched. Randomised clinical trials (RCTs) evaluating corticosteroids for the purpose of preventing extubation failure in mechanically ventilated, critically ill patients of all ages were included. Two authors independently assessed the validity of included studies and extracted data regarding characteristics of the studies and the rates of reintubation and manifestations of laryngeal oedema.
Fourteen RCTs including 2,600 participants were included. The mean duration of ventilation prior to attempted extubation ranged from 3 to 21 days. There was a reduction in reintubation with the use of corticosteroids, with a pooled odds ratio (OR) of 0.56 (95% CI; 0.41–0.77, P < 0.0005). The effect of corticosteroids tended to be more pronounced in studies when used at least 12 h prior to attempted extubation (OR 0.41, 95% CI; 0.26–0.64). The results were consistent across neonatal, paediatric and adult populations. There was also a reduction in laryngeal oedema in participants receiving corticosteroids, with a pooled OR of 0.36 (95% CI 0.27–0.49, P < 0.0005).
Corticosteroids reduce laryngeal oedema and importantly reduce the incidence of extubation failure in critically ill patients of all ages.
KeywordsMechanical ventilation Weaning Peri-operative care Artifical airways Complications
- 4.Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, Macias S, Allegue JM, Blanco J, Carriedo D, Leon M, de la Cal MA, Taboada F, Gonzalez de Velasco J, Palazon E, Carrizosa F, Tomas R, Suarez J, Goldwasser RS (1997) Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 156:459–465PubMedGoogle Scholar
- 13.Harel Y, Vardi A, Quigley R, Brink LW, Manning SC, Carmody TJ, Levin DL (1997) Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients. Int J Pediatr Otorhinolaryngol 39:147–158PubMedCrossRefGoogle Scholar
- 17.MetaRegister of controlled trials (2008) Medical Editors’ Trial Amnesty. Cochrane Library, OxfordGoogle Scholar
- 18.Markovitz BP, Randolph AG, Khemani RG (2008) Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev:CD001000Google Scholar
- 27.Darmon JY, Rauss A, Dreyfuss D, Bleichner G, Elkharrat D, Schlemmer B, Tenaillon A, Brun-Buisson C, Huet Y (1992) Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study. Anesthesiology 77:245–251PubMedCrossRefGoogle Scholar
- 32.Shih CM, Chen W, Tu CY, Chen HJ, Lee JC, Tsai WK, Hsu WH (2007) Multiple injections of hydrocortisone for the prevention of post-extubation stridor in acute respiratory failure. Poster 102 in: Proceedings of Conference of the American Thoracic Society, San Francisco, May 2007Google Scholar
- 34.Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW Jr, Zaza S (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490PubMedCrossRefGoogle Scholar