Steroid on Laryngeal Edema in Prolonged Intubation Observed by Repeated Cuff Leak Tests-a Case Report

Abstract

Post-extubation laryngeal edema may induce stridor and even reintubation. Cuff leak test has been reported as a valuable method to predict post-extubation laryngeal stridor. Steroid has been reported to contribute to the prevention of post-extubation laryngeal edema in children. However, the studies for adults were scanty and the result remains controversial. We report a 71 year-old female who was admitted due to cerebrovascular accident with dementia. She suffered acute respiratory failure due to pneumonia. She experienced extubation failure due to laryngeal edema. Her family refused early tracheostomy due to local custom. Therefore we had a rare chance to observe the course of laryngeal edema after prolonged intubation and its relationship with steroid dosage. We found an interesting trend of increase of cuff leak when the dose of steroid was added to intravenous solu-cortef 100 mg per 6 hours and decrease after the steroid was discontinued. This is a new method to make series observation of the severity of laryngeal edema and under the arrangement we can see how much dose and how long of duration of the treatment with steroid may improve laryngeal edema. However, the suitable case is rare and further studies may need the cooperation of multiple hospitals.