Airway Obstruction
Conditions
Keywords
Endotracheal intubation, Laryngeal edema, Cuff-leak test, Corticosteroids, This study was to ascertain whether administration of dexamethasone to critically intubated patients prevent postextubation airway obstruction., This study was to compare high dose and low dose dexamethasone in preventing noninvasive ventilation or reintubation among critically ill intubated patients
Brief summary
The specific objectives were to determine whether high dose dexamethasone are more effective than low dose dexamethasone in the reduction or prevention of post-extubation airway obstruction among patients with a cuff leak volume (CLV) \< 110 mL.
Detailed description
Controversy currently exists regarding the effectiveness of prophylactic steroid therapy for patients considered at high risk for post-extubation stridor. Studies regarding the efficacy of prophylactic corticosteroids for intubated patients have yielded conflicting results due to differences in the number, dose, or type of corticosteroids administered. Only a limited number of prospective trials involving adults and evaluating the benefits and the dose of corticosteroid therapy prior to extubation have been conducted.The present study was conducted to evaluate the effects of prophylactic dexamethasone therapy for a subset of high-risk patients who had been intubated for \> 48 hours and who were undergoing their first elective extubation in an ICU setting.
Interventions
DRUGdexamethasone (Oradexon, Nederland)
dexamethasone 5mg was administered every 6 hour for 1 day in group 1 and dexamethasone 10mg was administered every 6 hour for 1 day in group 2
Sponsors
Mackay Memorial Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 95 Years
Healthy volunteers
No
Inclusion criteria
All patients were \> 18 years of age and met the following weaning criteria: 1. Temperature ≤ 38°C for \> 8 hours, 2. Discontinuous use of sedatives, 3. Heart rate ≥ 70 and ≤ 130 /min, 4. Systolic blood pressure (SBP) ≥ 80 mm Hg in the absence of vasopressors, 5. Fraction of inspired oxygen (FiO2) ≤ 0.6, PaO2 ≥ 60, and partial pressure of oxygen (PaO2)/FiO2 ratio \> 200, 6. Positive end-expiratory pressure (PEEP) ≤ 5 cm H2O, 7. Rapid and shallow ratio of frequency to tidal volume (f/VT ≤ 105), 8. Minute ventilation ≤ 15 L/min, and 9. pH ≥ 7.3. Supplemental oxygen was continued to maintain an oxygen saturation \> 95% as measured by a pulse oximeter.
Exclusion criteria
1. A history of extubation during the same hospitalization 2. Administration of corticosteroids seven days prior to extubation.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| absolute cuff leak volumes and relative cuff leak volume to tidal volume(%)(measured CLV-baseline CLV) X 100/ tidal volume) | 48 hours |
Countries
Taiwan
Contacts
Primary ContactChao-Hsien Lee, MD
Outcome results
None listed