PURPOSE: Postextubation stridor can prolong ICU stay and increase mortality rate. This arises from the reactive edema in the glottic or subglottic mucosa from pressure of the endotracheal tube. Intubated patients with cuff leak volume above 25% of the tidal volume are at high risk for postextubation stridor. The use of corticosteroids may offer protection because of their anti-inflammatory effects. Corticosteroids, however, may cause adverse effects hence a more systematic assessment of its efficacy is warranted prior to adoption of this practice. This study aims to determine whether prophylactic use of systemic corticosteroids prevents postextubation stridor and subsequent reintubation from laryngeal edema. It also aims to site the deleterious effects of this recommendation.
METHODS: Literature search was made using Medline through PubMed, Cochrane Collaboration of Studies and Ovid. All meta-analysis and randomized placebo controlled trials using systemic steroids in the prevention of postextubation laryngeal edema, stridor and reintubation among intubated ICU adult patients were included. Methodological quality was assessed and data were independently extracted by two reviewers. Statistical analysis was made through Review Manager 4.2.
RESULTS: Three out of six studies of high methodologic value were included. Prophylactic use of steroids prevents the development of laryngeal edema and postextubation stridor (RR 0.67, 95% CI [0.46, 0.97]). Risk for reintubation is also decreased with intravenous corticosteroids (RR 0.54 95% CI [0.30, 0.94]). The studies included were homogenous (test for heterogeneity = 0.66). There is no statistical difference in the outcomes of interest between single or multiple doses of prophylactic intravenous steroids .
CONCLUSION: Use of systemic corticosteroids prior to extubation prevents the development of post extubation laryngeal edema, stridor and need for reintubation especially among high risk populations (cuff leak volume >25% of the tidal volume). There are no obvious side effects of prophylactic treatment.
CLINICAL IMPLICATIONS: High risk patients for postextubation laryngeal edema should receive prophylactic intravenous steroids as this translates to lower morbidity and risk for reintubation. Studies however should be directed towards proper identification of these high risk patients.
DISCLOSURE: Albert Albay, No Financial Disclosure Information; No Product/Research Disclosure Information