A Randomized Controlled Trial of Dexamethasone as a Prophylactic Treatment for Subglottic Stenosis in a Rabbit Model

Abstract

Objective: Iatrogenic injury is a common cause of subglottic stenosis (SGS). We investigated the role of pre-injury dexamethasone as a preventive treatment for iatrogenic subglottic stenosis. Methods: 16 New Zealand White rabbits were used in an IACUC approved study. Subjects were divided into two groups: intramuscular dexamethasone (DEX) at a dose of 2 mg/kg 15 minutes prior to an endoscopic injury to create SGS, and the same injury creation with a preoperative intramuscular saline (SAL) injection. Three independent, blinded raters evaluated endoscopic images to obtain cross sectional area (CSA) airway measurements. Rabbit airways were measured just prior to injury and at one week post-injury. All subjects were provided as-needed postoperative steroids and buprenorphine for symptoms of respiratory distress. Data analysis was performed using Student t-test. Intraclass correlation coefficients were used to assess inter-rater agreement. Results: All subjects survived to the one-week post-injury airway evaluation. There was no difference in airway size between groups prior to injury ( P = .28). Subjects in the DEX group demonstrated an average stenosis of 20.3% (95% CI 10.2-30.5) at one week compared to 60.6% (95% CI 40.3-80.9) in the SAL group ( P = .01). Subjects in the control group required significantly more doses of postoperative dexamethasone ( P = .02). Inter-rater agreement for between raters was excellent (ICC = .88). Conclusion: This is the first study to examine the role of pre-injury glucocorticoids in preventing iatrogenic subglottic stenosis. In our model, a single dose of intramuscular dexamethasone given prior to a subglottic injury resulted in a statistically significant reduction in airway stenosis. This research suggests that administering systemic dexamethasone should be considered prior to any procedure that may injure the subglottis, including traumatic intubation, to prevent iatrogenic subglottic stenosis.

Systemic Steroids for Otolaryngology–Head and Neck Surgery Disorders: An Evidence‐Based Primer for Clinicians

“…A systematic review of wound‐healing agents found that SCS were poorly investigated, 162 and no relevant CPG is available. In a 2021 RCT in rabbit models, systemic administration of dexamethasone prior to induction of subglottic injury resulted in less airway stenosis 163 . The evidence on use of SCS as adjuvant treatment once stenosis is present is inconsistent.…”

“…In a 2021 RCT in rabbit models, systemic administration of dexamethasone prior to induction of subglottic injury resulted in less airway stenosis. 163 The evidence on use of SCS as adjuvant treatment once stenosis is present is inconsistent.…”

Surgical management of complex neonatal airway abnormalities

“…Endoscopic balloon dilation has proven to be a useful approach in neonates and may be successful in avoiding a tracheostomy in the neonatal period. Animal models have helped to refine the technique and have shown the value of antibiotic/steroid adjuncts [11]. At times an overlooked cause of acquired SGS, Bowles et al updated their previously published experience with subglottic cysts.…”