Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study
https://ccforum.biomedcentral.com/articles/10.1186/cc5957
Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlle
Introduction Prophylactic steroid therapy to reduce the occurrence of postextubation laryngeal edema is controversial. Only a limited number of prospective trials involve adults in an intensive care unit. The purpose of this study was to ascertain whether
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Results
Administration of dexamethasone during the 24-hour period preceding extubation resulted in a statistically significant increase in the CLV (p < 0.05). The significant increase of CLV and change of CLV relative to baseline tidal volume (percentage) occurred not only throughout the treatment period, but also 24 hours after the last dexamethasone injection. The incidence of postextubation stridor was significantly lower in the dexamethasone group than in the placebo group (10% [4/40] versus 27.5% [11/40]; p = 0.037), whereas there was no significant difference in reintubation rate between the two groups (2.5% [1/40] versus 5% [2/40]; p = 0.561).
Conclusion
Prophylactic administration of multiple-dose dexamethasone is effective in reducing the incidence of postextubation stridor in adult patients at high risk for postextubation laryngeal edema. The after-effect of dexamethasone may validate the reduced incidence of postextubation stridor after multiple doses of dexamethasone.
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extubation 후에 후두부종으로 재삽관률 증가
> 덱사메타손 스테로이드 투여 > 발관후 후두부종, 기도협착 감소
(스테로이드의 항염증, 부종억제효과)
덱사메타손을 예방적으로 투여하는 것은 발관 후 후두 부종 위험이 높은 성인 환자의 발관 후 협착음 발생률을 줄이는 데 효과적, 덱사메타손의 후효과는 다중 용량의 덱사메타손 투여 후 발관 후 협착음 발생률이 감소
기관 삽관과 관련된 후두기관 손상은 성문 부종으로 인해 기도 협착 > 후두 부종은 36시간 이상 기관 내 삽관 후에 흔함 > 이 부위의 부종은 발관 후 호흡음 위험 증가와 관련 이 있으며, 이는 재삽관률을 증가. 재삽관은 이환율과 사망률을 초래