POSTEXTUBATION LARYNGEAL EDEMA IN ADULTS - RISK FACTOR EVALUATION ANDPREVENTION BY HYDROCORTISONE

Objective: To evaluate the risk factors for postextubation laryngeal s trider and its prevention by hydrocortisone in adult patients. Design: Prospective, randomized, double-blind, placebo controlled study. Sett ing: Medical and surgical ICU of a tertiary teaching hospital. Patient s: 77 consecutive patients of both sexes, who had undergone tracheal i ntubation for more than 24 h and fulfilled the weaning criteria, were eligible for the study. Patients were excluded if they were less than 15 years of age, had a disease or the surgery of the throat, or had be en extubated during the current hospitalization. Intervention: The con trol group received placebo (normal saline 3 cc) and the experimental group received hydrocortisone 100 mg by intravenous infusion 60 min be fore extubation. Main outcome measures: Patients were observed 24 h af ter extubation for symptoms or signs of laryngeal edema or strider: pr olonged inspiration with accessory usage of respiratory muscles or cro wing sound with inspiration or reintubation. Results: The overall inci dence of postextubation strider was 22% (17/77). Only one patient (1%) , who belonged to the control group, needed reintubation. 39% of femal e patients and 17% of male patients developed strider. The relative ri sk of females developing this complication was 2.29. 7/39 of the hydro cortisone group and 10/38 of patients in the control group developed p ostextubation strider. Conclusions: Hydrocortisone did not significant ly reduce the incidence of postextubation laryngeal edema or strider. From the risk factors evaluated, we were unable to demonstrate a stati stical correlation between postextubation stidor and the duration of t he intubation, the patient's age, the internal diameter of the endotra cheal tube, or the route of intubation. However, female patients were more likely to develop this complication.