Role of dexamethasone for prevention of post-extubation airway obstruction in critically ill adult patients

ABSTRACT

To evaluate whether dexamethasone started 24 hours prior to planned tracheal extubation in adults, can prevent post-extubation laryngeal oedema. Randomized placebo-controlled double-blind trial. Department of Anaesthsiology, Surgical ICU and Pain Management, Jinnah Postgraduate Medical Centre Karachi, from August 2006 to July 2008. Ninety-two patients who met weaning criteria after being intubated for more than 48 hours, with a cuff leak volume [CLV] of less than 110 ml were randomly allocated to two groups; receive either intravenous dexamethasone [5 mg] or identical volume of intravenous placebo [normal saline], and continued every six hours thereafter, for a total of four doses [total dose 20 mg] on the day preceding extubation. Cuff leak volume was measured at the time of the first injection, and one hour after each injection and 24 hours after the last injection. Patients were extubated twenty-four hours after the last injection of dexamethasone or identical volume of intravenous placebo. Occurrence of stridor was noted within 48 hours of extubation. Dexamethasone injection 24 hours prior to extubation increased the CLV significantly [P=0.001]. Post-extubation stridor was 54.6% significantly lower in the dexamethasone group than in placebo group [6/46 versus 15/46, P=0.025]. Dexamethasone given every six hours intravenously, commencing 24 hours before a planned tracheal extubation, substantially reduced the incidence of post-extubation stridor and re-intubation, in adult patients at high risk for post-extubation laryngeal oedema, as identified by the cuff leak test