Anjali R Varghese, Pratyusha Kambagiri, Manas R Sahoo, Atul Jindal, Anil K Goel
{"title":"静脉注射地塞米松在预防儿科重症监护室机械通气患儿拔管后气道阻塞中的作用：一项双盲随机对照试验","authors":"Anjali R Varghese, Pratyusha Kambagiri, Manas R Sahoo, Atul Jindal, Anil K Goel","doi":"10.5005/jp-journals-10071-24830","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To study the efficacy of intravenous dexamethasone in preventing postextubation airway obstruction (PEAO).</p><p><strong>Design: </strong>A double-blinded randomized controlled trial.</p><p><strong>Study setting: </strong>The study was conducted in level 3 PICU at AIIMS, Raipur, India, from December 2019 to September 2022.</p><p><strong>Subjects: </strong>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.</p><p><strong>Intervention: </strong>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).</p><p><strong>Outcome: </strong>The occurrence of any clinically significant stridor (Westley stridor score ≥3) was the primary outcome.</p><p><strong>Measurements and main results: </strong>Of the seventy (<i>n</i> = 70) children included in the study, 35 received dexamethasone while 35 received placebo. Westley stridor score ≥3 was present in 25.71% (<i>n</i> = 9) in dexamethasone group vs 31.42% (<i>n</i> = 11) in placebo (<i>p</i> = 0.792). Reintubation occurred in 14.28% (<i>n</i> = 10/70) patients, 11.42% (4/35) in dexamethasone group, and 17.14% (6/35) in placebo group (<i>p</i> = 0.734). Five children in the dexamethasone group and six in placebo group died (<i>p</i> = 1.00). There was no difference in the length of PICU stay (<i>p</i> = 0.84) and hospital stay (<i>p</i> = 0.75) among both the groups.</p><p><strong>Conclusion: </strong>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.</p><p><strong>How to cite this article: </strong>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.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"28 11","pages":"1063-1068"},"PeriodicalIF":1.5000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773586/pdf/","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Anjali R Varghese, Pratyusha Kambagiri, Manas R Sahoo, Atul Jindal, Anil K Goel\",\"doi\":\"10.5005/jp-journals-10071-24830\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To study the efficacy of intravenous dexamethasone in preventing postextubation airway obstruction (PEAO).</p><p><strong>Design: </strong>A double-blinded randomized controlled trial.</p><p><strong>Study setting: </strong>The study was conducted in level 3 PICU at AIIMS, Raipur, India, from December 2019 to September 2022.</p><p><strong>Subjects: </strong>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.</p><p><strong>Intervention: </strong>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).</p><p><strong>Outcome: </strong>The occurrence of any clinically significant stridor (Westley stridor score ≥3) was the primary outcome.</p><p><strong>Measurements and main results: </strong>Of the seventy (<i>n</i> = 70) children included in the study, 35 received dexamethasone while 35 received placebo. Westley stridor score ≥3 was present in 25.71% (<i>n</i> = 9) in dexamethasone group vs 31.42% (<i>n</i> = 11) in placebo (<i>p</i> = 0.792). Reintubation occurred in 14.28% (<i>n</i> = 10/70) patients, 11.42% (4/35) in dexamethasone group, and 17.14% (6/35) in placebo group (<i>p</i> = 0.734). Five children in the dexamethasone group and six in placebo group died (<i>p</i> = 1.00). There was no difference in the length of PICU stay (<i>p</i> = 0.84) and hospital stay (<i>p</i> = 0.75) among both the groups.</p><p><strong>Conclusion: </strong>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.</p><p><strong>How to cite this article: </strong>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. 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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.
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.
期刊介绍：
Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.
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