A Cochrane review [Abstract] 1 included 11 studies with a total of 2 301 subjects. Six studies were conducted in adults, two in neonates and three in children. All but one examined use of steroids for the prevention of post-extubation stridor; the remaining one concerned treatment of existing post-extubation stridor in children. Dexamethasone given intravenously at least once prior to extubation was the most common steroid regimen utilized (uniformly in neonates and children).
In neonates there was an overall non significant reduction in post extubation stridor (RR 0.42; 95% CI 0.07 to 2.32). This decrease was seen only in the study on high-risk patients treated with multiple doses of steroids around the time of extubation. In children, prophylactic corticosteroids tended to reduce reintubation and significantly reduced post-extubation stridor in the study that included children with underlying airway abnormalities (N = 62) but not in the study that excluded these children (N = 153). In six adult studies (total N = 1 953), there was a non significant trend for prophylactic corticosteroid administration to reduce the risk of re-intubation (RR 0.48; 95% CI 0.19 to 1.22) and a significant reduction in the incidence of post extubation stridor (RR 0.47; 95% CI 0.22 to 0.99, significant heterogeneity I2 81%). Subgroup analysis revealed that post extubation stridor could be reduced in adults with a high likelihood of post extubation stridor when corticosteroids were administered as multiple doses begun 12-24 hours prior to extubation compared to single doses closer to extubation. Side effects were uncommon and could not be aggregated.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (wide confidence intervals).
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