DEXAMETHASONE FOR THE PREVENTION OF POSTEXTUBATION AIRWAY-OBSTRUCTION- A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Objective: To determine whether dexamethasone prevents postextubation airway obstruction in young children. Design: Prospective, randomized, double blind, placebo controlled study. Setting: Pediatric intensive care unit of a university teaching hospital. Patients: Sixty-six child ren, <5 yrs of age, intubated and mechanically ventilated for >48 hrs. Interventions: Patients were randomized to receive intravenous dexame thasone (0.5 mg/kg, maximum dose 10 mg) or saline, every 6 hrs for six doses, beginning 6 to 12 hrs before elective extubation. Measurements and Main Results: Dependent variables included the presence of stride r, Group Score, and pulsus paradoxus at 10 mins, 6, 12, and 24 hrs aft er extubation; need for aerosolized racemic epinephrine and reintubati on. The dexamethasone and placebo groups were similar in age (median 3 months [range 1 to 57] vs. 4 months [range 1 to 59], p = .6), frequen cy of underlying airway anomalies (3/33 vs. 3/33, p = 1.0), and durati on of mechanical ventilation (median 3.3 days [range 2.1 to 39] vs. 3. 5 days [range 2.1 to 15], p = .7). The dexamethasone group had a lower frequency of strider, Croup Score, and pulsus paradoxus measurement a t 10 mins and at 6 and 12 hrs after extubation. Fewer dexamethasone-tr eated patients required epinephrine aerosol (4/31 vs. 22/32, p < .0001 ) and reintubation (0/31 vs. 7/32, p < .01). Three patients exited the study early-one patient in the dexamethasone group had occult gastroi ntestinal hemorrhage and one patient in each group had hypertension. C onclusion: Pretreatment with dexamethasone decreases the frequency of postextubation airway obstruction in children.