Abstract
Aims & Objectives: Multidose dexamethasone pretreatment prevents postextubation airway obstruction (PEAO), however optimal dose is not known. Study was designed to compare effect of 24h pretreatment of low dose (LD) (0.25mg/kg/dose) versus high dose (HD) (0.5mg/kg/dose) dexamethasone for prevention of PEAO and reintubation. Methods: Design: Randomized open-label controlled trial. Setting and Participants: Children (3mo-12yrs) intubated for ≥48h and planned for first extubation (n=287) in a tertiary care hospital of a developing country. Interventions: Patients were randomized (and stratified for age and intubation duration) to receive LD (n=144) or HD (n=143) dexamethasone (q6h) for total of 6 doses. Extubation was planned immediately after 5th dose. Patients with preexisting upper airway conditions, chronic respiratory diseases, steroid or IVIG therapy in last 7 days, gastrointestinal bleeding, hypertension and hyperglycemia were excluded. Main Outcome Measure: Development of PEAO (Westley’s Croup Score ≥4) requiring adrenaline nebulization and/or reintubation during first 24h. Results: Two hundred thirty-eight patients were included in per-protocol analysis. Seventy-eight (33%) patients developed PEAO, with no difference in the two groups (HD, 37/117, 31.62% vs LD, 41/121, 33.88%) (p=0.71). Incidence of reintubation was also similar (HD, 9/117, 7.7% vs LD, 10/121, 8.3%) (p=0.87). Intubation for >7days was independent risk factor for PEAO. Conclusions: Multidose 24h pretreatment with low dose dexamethasone was equally effective as high dose in prevention of PEAO and reintubation in the prevalent clinical scenario of the study period. Trials among children at high risk of developing PEAO may be the subject of future work.
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