Authors
1 Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Epidemiologist, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: The efficacy of steroid administration in the prevention of postextubation complications in critical care remains controversial. The purpose of this study was to determine whether administration of nebulized budesonide in critically ill patients reduces the occurrence of postextubation airway complications.
Materials and Methods: This was a prospective, randomized, double-blind, placebo-controlled study.We prospectively followed up 70 adult patients in the intensive care unit who were intubated for more than 48 h. Patients received either nebulized budesonide (1 mg every 12 h; n = 35) or placebo (normal saline; n = 35) until 48 h after extubation. Then, the postextubation complications were assessed and recorded within 48 h of extubation.
Results: The incidence of respiratory distress was lower in budesonide group (8.6% vs. 31.4%, P = 0.017). Reintubation with mechanical support was necessary in 8.6% (3.35) of patients in the budesonide group and 31.4% (11.35) of patients in the placebo group (P = 0.017).
Conclusion: Nebulized budesonide after extubation is effective in reducing the incidence of reintubation and respiratory distress in adult patients.
Keywords
1. | Epstein SK. Corticosteroids prevent of post-extubation upper airway obstruction. Crit Care 2007;11:156. |
2. | Cheng KC, Hou CC, Huang HC, Lin SC, Zhang H. Intravenous injection methylprednisolone reduces the incidence of post-extubation stridor in ICU. Crit Care Med 2006;34:1345-50. |
3. | Meade MO, Guyatt GH, Cook DJ, Sinuff T, Butler R. Trial of corticosteroids to prevent of post-extubation airway complications. Chest 2001;120 (6 Suppl):464S-8. |
4. | Wang CL, Tsai YH, Huang CC, Wu YK, Ye MZ, Chou HM, et al. The role of cuff leak test in predicting the effect of corticosteroid treatment on post-extubation stridor. Chang Gung Med J 2007;30:53-61. |
5. | Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC. Post-extubation laryngeal edema and extubation failure. Crit Care 2009;13:233. |
6. | Sandhu RS, Pasquale MD, Miller K, Wasser TE. Measurement of endotracheal tube cuff leak to predict postextubatoin strior and need for reintubation. J Am Coll Surg 2000;190:682-7. |
7. | Lee CH, Peng MJ, Wu CL. Dexametas one to prevent post-extubation airway obstraction in adults. Crit Care 2007;11:R72. |
8. | Sinha A, Jayashree M, Singhi S. Aerosolized L-epinephrine vs budesonide for post-extubation stridor. Indian Pediatr 2010;47:317-22. |
9. | Young D, Watkinson P. Preventing post-extubation airway complication in adults. BMJ 2008;337:a1565. |
10. | François B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, et al. 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: A randomised double-blind trial. Lancet 2007;369:1083-9. |
11. | Malhotra SA, Curgoo AN, Shora AK, Farooqi MS, Qazi BA, Dar SQ. Role of dexamethasone in prevention of post extubation upper airway complications in paediatric patients in an intensive care unit. Internet J Anesthesiol 2009;19:1. |