Steroid use is complex in intensive care

doi:10.1136/bmj.a2682

Published 25 November 2008, doi:10.1136/bmj.a2682
Cite this as: BMJ 2008;337:a2682

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Steroids and extubation

Steroid use is complex in intensive care

The first 150 words of the full text of this article appear below.

The six trials in the meta-analysis of prophylactic parenteralsteroid use to prevent laryngeal oedema after extubation, andsubsequent reintubation, use different agents and non-equivalentdoses.¹ Biological half lives vary considerably, hydrocortisonebeing shortest acting, methylprednisolone intermediate, anddexamethasone longest (36-54 h). Steroids’ corticosteroidrather than mineralocorticoid activity is most likely responsiblefor reducing laryngeal oedema. The table shows how these studiesdiffered regarding their equivalent dose of dexamethasone, whichhas mainly corticosteroid effects.

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Steroid doses in six trials of meta-analysis of Fan and colleagues¹

In the UK, patients in intensive care receive steroids for manyreasons, and a prospective placebo-controlled trial to addresslaryngeal oedema may not be possible or ethical. Most admissionsare postoperative or for sepsis. In surgery 8-10 mg intraoperativedexamethasone is commonly used with other anti-emetic drugsto prevent postoperative nausea and vomiting and may still beactive after 3-5 days.² In poorly responsive septic . . . [Full text of this article]

Amit Patel, NIHR academic clinical fellow¹

¹ Imperial College London, Hammersmith Hospital, London W12 0NN

amit.patel@imperial.ac.uk

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