Abstract
Post extubation stridor is due to reactive subglottic laryngeal edema at the cricoid ring. Dexamethasone has been used to reduce the incidence of stridor in such patients. The evidence in the literature however is not conclusive. We conducted a prospective, randomized, double blind study of dexamethasone versus placebo to assess the efficacy of dexamethasone in reducing the incidence of post extubation stridor in children. Fifty-one patients without any known preexisting upper airway problems were studied. There were 27 patients in the treatment group and 24 in the placebo group. Both groups had similar weight, age and length of intubation. Dexamethasone was given at a dose of 0.6 mg/kg at 12 h and 1 h prior to extubation for a total of 2 doses. The control group received placebo at corresponding times. There was no statistical difference in the incidence of post extubation stridor in the two groups. Ten of 24 children in the placebo group (41.7%) and 8 of 27 (30%) in the dexamethasone group developed stridor (P = 0.39). There were 3 patients in placebo group and 1 in dexamethasone group that needed reintubation, but again the difference was not statistically significant (P = 0.33). This study, although with relatively small sample size, suggests that routine use of dexamethasone to prevent post extubation stridor, in children without any known upper airway abnormality, is not warranted.
Highlights
Ill patients requiring intensive care are at risk of iatrogenic ocular damage
Intensive Care Unit (ICU) management of critically ill patients often includes the requirement for tracheostomy and feeding access, most often a pecutaneous endoscopic gastrostomy (PEG)
Percutaneous tracheostomy is performed routinely in many medical intensive care unit (ICU) settings, in high risk surgical and trauma patients who often have unstable cervical spine injury and tissue edema, direct visualization of the cervical structures and trachea is imperative during tracheostomy
Summary
Ill patients requiring intensive care are at risk of iatrogenic ocular damage. We designed an experimental situation where external cardiac pressure conditions were controlled and adjusted to physiological extremes to mimic clinically relevant situations, while cardiac performance was assessed using left ventricular pressure–volume relationships (LVPVR) which are relatively preload and afterload independent This prospective, controlled study was undertaken to evaluate the response to therapy aimed at achieving supranormal cardiac and oxygen transport values (cardiac index >4.5 l/min/m2, oxygen delivery >600 l/min/m2, and oxygen consumption >170 l/min/m2) in patients older than 60 or with previous severe cardiorespiratory illnesses, who have undergone elective extensive ablative surgery planned for carcinoma or abdominal aortic aneurism. Whilst some human studies conducted in the critically ill and in high risk surgical patients have suggested that dopexamine may cause an increase in tonometrically measured gastric intra-mucosal pH (pHi) and an improvement in clinical outcome, this has not been confirmed in other randomised trials. In the present study the association of platelet function to inflammatory markers indicating disease severity was investigated
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