Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

doi:10.1136/bmj.a1841

Published 20 October 2008, doi:10.1136/bmj.a1841
Cite this as: BMJ 2008;337:a1841

Research

Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials

Tao Fan, medical student¹, Gang Wang, associate professor and respiratory physician¹, Bing Mao, associate professor and respiratory physician¹, Zeyu Xiong, research associate², Yu Zhang, critical care physician³, Xuemei Liu, research associate⁴, Lei Wang, respiratory physician¹, Sai Yang, respiratory and critical care physician⁵

¹ Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China, ² Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA, ³ Department of Intensive Care Medicine, First People’s Hospital of Chengdu City, Chengdu 610041, China, ⁴ Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, ⁵ Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu

Correspondence to: G Wang wcums-respiration{at}hotmail.com

Objective To determine whether steroids are effective in preventinglaryngeal oedema after extubation and reducing the need forsubsequent reintubation in critically ill adults.

Design Meta-analysis.

Data sources PubMed, Cochrane Controlled Trials Register, Webof Science, and Embase with no limitation on language, studyyear, or publication status.

Selection criteria Randomised placebo controlled trials in whichparenteral steroids were compared with placebo for preventingcomplications after extubation in adults.

Review methods Search, application of inclusion and exclusioncriteria, data extraction, and assessment of methodologicalquality, independently performed in duplicate. Odds ratios with95% confidence intervals, risk difference, and number neededto treat were calculated and pooled.

Main outcome measures Primary outcome: laryngeal oedema afterextubation. Secondary outcome: subsequent reintubation becauseof laryngeal oedema.

Results Six trials (n=1923) were identified. Compared with placebo,steroids given before planned extubation decreased the oddsratio for laryngeal oedema (0.38, 95% confidence interval 0.17to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58), correspondingwith a risk difference of –0.10 (–0.12 to –0.07;number needed to treat 10) and –0.02 (–0.04 to –0.01;50), respectively. Subgroup analyses indicated that a multidoseregimen of steroids had marked positive effects on the occurrenceof laryngeal oedema (0.14; 0.08 to 0.23) and on the rate ofsubsequent reintubation (0.19; 0.07 to 0.50), with a risk differenceof –0.19 (–0.24 to –0.15; 5) and –0.04(–0.07 to –0.02; 25). In single doses there wasonly a trend towards benefit, with the confidence interval including1. Side effects related to steroids were not found.

Conclusion Prophylactic administration of steroids in multidoseregimens before planned extubation reduces the incidence oflaryngeal oedema after extubation and the consequent reintubationrate in adults, with few adverse events.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant Articles

Steroid use is complex in intensive care: Amit Patel
BMJ 2008 337: a2682. [Extract] [Full Text]

Preventing postextubation airway complications in adults: Duncan Young and Peter Watkinson
BMJ 2008 337: a1565. [Extract] [Full Text]

This article has been cited by other articles:

Fowler, R. A., Adhikari, N. K. J., Scales, D. C., Lee, W. L., Rubenfeld, G. D. (2009). Update in Critical Care 2008. Am. J. Respir. Crit. Care Med. 179: 743-758 [Full text]
Patel, A. (2008). Steroid use is complex in intensive care. BMJ 337: a2682-a2682 [Full text]
Young, D., Watkinson, P. (2008). Preventing postextubation airway complications in adults. BMJ 337: a1565-a1565 [Full text]

Rapid Responses:

Read all Rapid Responses

Ubiquitous steroid use in the intensive care unit: Amit Patel
bmj.com, 22 Oct 2008 [Full text]
Prophylactic steroids to prevent �extubation failure� in ventilated children: Joseph L Mathew, et al.
bmj.com, 26 Oct 2008 [Full text]
Corticosteroids pharmacodynamics explains late effects and may be critical to optimize therapeutic outcomes.: Fernando Martins do Vale
bmj.com, 10 Nov 2008 [Full text]
Major post extubation stridor in ICU is not common: Cecily M D Don, et al.
bmj.com, 17 Nov 2008 [Full text]
Post extubation laryngeal oedema in anesthesia for surgical adult patients: Mohamad Said Maani Takrouri, et al.
bmj.com, 4 Jan 2009 [Full text]
Post extubation laryngeal oedema in anesthesia for surgical adult patients: Mohamad Said Maani Takrouri, et al.
bmj.com, 5 Jan 2009 [Full text]
It�s the 30th birthday of �Evidence Based Medicine� and time to meet Cochrane�s Challenge.: Tony K Chow, et al.
bmj.com, 21 Jan 2009 [Full text]