Use of Dexamethasone to Prevent Extubation Failure in Pediatric Intensive Care Unit: A Randomized Controlled Clinical Trial

Carvalho, Haroldo Teófilo de; Fioretto, José Roberto; Bonatto, Rossano César; Ribeiro, Cristiane Franco; Martin, Joelma Gonçalves; Carpi, Mário Ferreira

doi:10.1055/s-0040-1719044

Cited by 4 publications

(26 citation statements)

References 28 publications

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“…There are few randomized double-blind studies performed in children 3 , 5 , 8 , 9 , 18 , 19 (one include adults and children 5 ), and our study is one of the largest (see Table 5 ). Two meta-analysis were published in 2009 4 , 20 .…”

Section: Discussionmentioning

confidence: 99%

Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children

Laiseca

Martín

Cortés

et al. 2022

Sci Rep

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To analyze the effectiveness of dexamethasone in preventing upper airway obstruction (UAO) symptoms after extubation and the need of reintubation in critically ill children. Multicenter, prospective, double-blind, randomized, phase IV clinical trial involving five pediatric intensive care units. Children between 1 month and 16 years-of-age intubated for more than 48 h were included. Patients were randomized to receive placebo or dexamethasone 0.25 mg/kg every 6 h, 6-to-12 h prior to extubation (four doses). 48 h follow-up was carried out after extubation. Severity of UAO symptoms (Taussig score, stridor) and reintubation requirement were compared. 147 patients were randomized (10 were excluded), 70 patients received dexamethasone and 67 placebo. No global differences were found in the presence of stridor or moderate-to-severe UAO symptoms (Taussig ≥ 5), but Taussig ≥ 5 was less frequent in patients less than 2 years-of-age treated with steroids (p = 0.014). Median Taussig score was lower in the dexamethasone group 1 h after extubation, p < 0.001. 27 patients required reintubation, 9 due to UAO: 3 (4.3%) in the dexamethasone group and 6 (8.9%) in the placebo group, p = 0.319. In those intubated > 5 days, reintubation due to UAO was higher in the placebo group (2.4% vs. 14.3, p = 0.052). Nebulized epinephrine and budesonide were required more frequently in the placebo group in the first 2 h (p = 0.041) and 1 h (p = 0.02) after extubation, respectively. No relevant side effects were observed. Dexamethasone prior to extubation did not significantly reduce moderate-severe UAO symptoms, except for patients under 2-years of age. Dexamethasone could decrease Taussig score and the need of rescue therapies, as well as reintubation rates in those intubated for more than 5 days.

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Section: Discussionmentioning

confidence: 99%

Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children

Laiseca

Martín

Cortés

et al. 2022

Sci Rep

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“…The full texts of 128 records were assessed for eligibility. A total of 8 randomized trials fulfilled the eligibility criteria and were included in the analysis (21)(22)(23)(24)(25)(26)(27)(28). All the included studies used Dexamethasone as the corticosteroid.…”

Section: Resultsmentioning

confidence: 99%

“…Details of the study characteristics are provided in Table E3. Six trials compared dexamethasone to either isotonic saline or no placebo (21)(22)(23)(24)(25)28). Two studies compared different dosing regimens of dexamethasone to each other (26,27).…”

Section: Resultsmentioning

confidence: 99%

“…In the NMA, we grouped the 8 trials (n=835) into five nodes evaluating outcomes of UAO and reintubation. In the 12-hour model (early use defined as dexamethasone initiation ≥12 hours prior to extubation), three studies were included in the high early node (n= 447) (23,26,27), 4 studies in the high late node (n= 400) (21,24,26,28), 1 study in low early node (n= 238)(27), 2 studies in low late node (n= 112) (22,25) and six studies were included in the no corticosteroid node (n=473) (21)(22)(23)(24)(25)28). Table 1a and 1b describe the relative effect estimates and absolute estimates for UAO and reintubation of the nodes with dexamethasone compared to the no dexamethasone node.…”

Section: Effects Of the Interventionsmentioning

confidence: 99%

“…Online supplement, Figure E1a, E1b Results of additional analyses 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression analyses, alternative network geometries studied, alternative choice of prior distributions for Bayesian analyses, and so forth).…”

Section: Risk Of Bias Across Studies 22mentioning

confidence: 99%

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A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children

et al. 2023

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Rationale: Peri-extubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. Objectives: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. Methods: MEDLINE, CINAHL and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 hours prior to extubation) and the dose (high dose: (>/= 0.5mg/kg/dose). We performed Bayesian network meta-analysis (NMA) with studies grouped into four regimens-High dose, Early use (HE); Low dose, Early use (LE); High dose, Late use (HL) and Low dose, Late use (LL).Results: 8 trials (n=903) were included in the analysis. For preventing UAO, (odds ratio, 95% credible interval), HE (0.13; 0.04, 0.36), HL (0.39; 0.19, 0.74) and LE (0.15; 0.04, 0.58) regimens appear to be more effective compared to no dexamethasone (low certainty). HE and LE had the highest probability of being the top ranked regimens for preventing UAO [surface under the cumulative ranking (SUCRA) 0.901 and 0.808 respectively]. For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared to no dexamethasone (very low certainty). HE and LE were the top ranked regimens (SUCRA 0.803 and 0.720 respectively) for preventing reintubation. Sensitivity analysis showed that regimens which started >12 hours prior to extubation were likely more effective than regimens started >6 hours prior to extubation.

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Operational Definitions Related to Pediatric Ventilator Liberation

Abu‐Sultaneh¹,

Iyer²,

Fernández³

et al. 2023

Chest

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Use of Dexamethasone to Prevent Extubation Failure in Pediatric Intensive Care Unit: A Randomized Controlled Clinical Trial

Cited by 4 publications

References 28 publications

Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children

Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children

A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children

Operational Definitions Related to Pediatric Ventilator Liberation

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