Wednesday, April 26, 2006

IV steroid in postextubation stridor

Thursday April 27, 2006
IV steroid to reduces postextubation stridor

Interesting study came out in May' 2006 issue of Critical Care Medicine regarding intravenous injection of methylprednisolone to reduce the incidence of postextubation stridor in intensive care unit patients. 128 patients who were intubated for more than 24 hrs with a cuff leak volume less than 24% of tidal volume but met weaning criteria were studied. 128 patients were divided into 3 groups.
  • placebo group (n = 43) with four injections of normal saline every 6 hrs,
  • 4 INJ group (n = 42) with four injections of methylprednisolone (40 mg every 6 hours)
  • 1 INJ group (n = 42) with one injection of the methylprednisolone (40 mg) followed by three injections of normal saline.

Extubation done one hour after last injection. Postextubation stridor was confirmed by examination using bronchoscopy or laryngoscopy.

Results shows that:
The incidences of postextubation stridor were lower both in the 1 injection (11.1%) and the 4 injections groups (7.1%) than in the control group (30.2%,). The side effects of steroids over 24 hrs were minimal with no obvious complications such as GI bleed, hyperglycemia, or increased risk of infection.

Please read full study for inclusion exclusion criteria, all outcomes, comparision with non-intervention group of 193 patients and discussion of study by authors.

Related previous pearl:
Cuff leak tests

References: click to get abstract
Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients - Critical Care Medicine. 34(5):1345-1350, May 2006