Role of Intravenous Dexamethasone in Prevention of Postextubation Airway Obstruction in Mechanically Ventilated Children in Pediatric Intensive Care Unit: A Double-blind Randomized Controlled Trial
Anjali R Varghese, Pratyusha Kambagiri, Manas R Sahoo, Atul Jindal, Anil K Goel
Keywords :
Dexamethasone, Mechanical ventilation, Pediatric intensive care unit, Postextubation airway obstruction, Stridor score
Citation Information :
Varghese AR, Kambagiri P, Sahoo MR, Jindal A, Goel AK. Role of Intravenous Dexamethasone in Prevention of Postextubation Airway Obstruction in Mechanically Ventilated Children in Pediatric Intensive Care Unit: A Double-blind Randomized Controlled Trial. Indian J Crit Care Med 2024; 28 (11):1063-1068.
Objective: To study the efficacy of intravenous dexamethasone in preventing postextubation airway obstruction (PEAO).
Design: A double-blinded randomized controlled trial.
Study setting: The study was conducted in level 3 PICU at AIIMS, Raipur, India, from December 2019 to September 2022.
Subjects: Children requiring intubation for at least 24 hours and not beyond 14 days were included. Children with upper airway anomalies or who received corticosteroids within the last 7 days were excluded.
Intervention: The children who satisfied the inclusion criteria were randomized into dexamethasone or placebo group by stratified variable block randomization. Dexamethasone (0.5 mg/kg/dose) or placebo was given four doses (–12 hr., –6 hr., 0 hr., and 6 hr. of extubation).
Outcome: The occurrence of any clinically significant stridor (Westley stridor score ≥3) was the primary outcome.
Measurements and main results: Of the seventy (n = 70) children included in the study, 35 received dexamethasone while 35 received placebo. Westley stridor score ≥3 was present in 25.71% (n = 9) in dexamethasone group vs 31.42% (n = 11) in placebo (p = 0.792). Reintubation occurred in 14.28% (n = 10/70) patients, 11.42% (4/35) in dexamethasone group, and 17.14% (6/35) in placebo group (p = 0.734). Five children in the dexamethasone group and six in placebo group died (p = 1.00). There was no difference in the length of PICU stay (p = 0.84) and hospital stay (p = 0.75) among both the groups.
Conclusion: Administration of multiple doses of dexamethasone may not help in the prevention of reintubation but may help in the reducing the incidence of clinically significant stridor.
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