PURPOSE: We sought to systematically summarize the evidence about the use of corticosteroids for the prevention of post-extubation stridor and need for re-intubation due to upper airway obstruction in adult patients.
METHODS: We searched multiple electronic databases (MEDLINE, Ovid EMBASE, Cochrane Central Register of Controlled Trials) from inception until February 2008, without any language restriction. Eligible studies were randomized trials of corticosteroids versus placebo. We used random effect model to calculate the pooled relative risk (RR) and corresponding 95% confidence interval (CI) of the effect of steroids on stridor and need for re-intubation. Inconsistency was estimated using the I2 statistic. We explored sources of heterogeneity using planned sensitivity analyses which were based on the duration of steroids (short course vs. long course), type of study population (< 36 hours intubation vs. > 36 hours intubation).
RESULTS: Six eligible trials were identified. The 6 studies had a combined population of 1923 subjects. Overall, steroids significantly reduced re-intubation risk (RR 0.33, CI: 0.17, 0.67; I2 = 0%; p=0.002), number needed to treat (NNT)=50. Moreover, steroids significantly reduced stridor incidence (RR 0.43, CI: 0.22, 0.86; I2 = 72.9%; p=0.02), NNT=10. Heterogeneity in this overall pooled estimate was explained by the duration of steroid use prior to extubation and by the population studied:. Long course steroids (RR: 0.2, 95% CI: 0.11, 0.36; I2 = 22.5%; p<0.001), NNT=5 vs. short course steroids (RR: 0.64, 95% CI: 0.40, 1.01; I2 = 0%; p=0.06), and trials that included patients that were intubated for more than 36 hours (RR: 0.65, 95% CI: 0.40, 1.05; I2 = 0%; p=0.08).
CONCLUSION: Prophylactic administration of corticosteroids before extubation reduces the incidence of upper airway obstruction in adults manifested by stridor and the need for reintubation.
CLINICAL IMPLICATIONS: Prophylactic use of corticosteroids prior to extubation is recommended to reduce the incidence of upperairway obstruction.
DISCLOSURE: Hani Lababidi, No Financial Disclosure Information; No Product/Research Disclosure Information