To receive artificial ventilation for acute respiratory failure adult patients usually have an endotracheal tube placed through the mouth and larynx into the upper trachea. Although initially life saving, the endotracheal tube causes mechanical irritation of the larynx and trachea, which in turn may cause inflammation and oedema. Infected oral secretions pooling in the larynx above the cuff of the endotracheal tube will exacerbate the inflammation. While present the endotracheal tube acts as a stent, but when it is removed these processes may narrow the upper airway, leading to symptoms and signs of upper airway obstruction and at worst the need for reintubation. In the linked meta-analysis (doi:10.1136/bmj.a1841), Fan and colleagues assess whether steroids are effective in preventing postextubation laryngeal oedema and reducing the need for subsequent reintubation of the trachea in critically ill adults.1

The scale of the problem is difficult to assess, because estimates of the incidence of signs or symptoms of upper airway obstruction after extubation vary from 2.3% in unselected ventilated patients2 to …