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.

Abstract

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.

How to cite this article: 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.