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

BMJ 2008; 337 doi: (Published 20 October 2008) Cite this as: BMJ 2008;337:a1841
  1. Tao Fan, medical student1,
  2. Gang Wang, associate professor and respiratory physician1,
  3. Bing Mao, associate professor and respiratory physician1,
  4. Zeyu Xiong, research associate2,
  5. Yu Zhang, critical care physician3,
  6. Xuemei Liu, research associate4,
  7. Lei Wang, respiratory physician1,
  8. Sai Yang, respiratory and critical care physician5
  1. 1Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
  2. 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
  3. 3Department of Intensive Care Medicine, First People’s Hospital of Chengdu City, Chengdu 610041, China
  4. 4Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu
  5. 5Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu
  1. Correspondence to: G Wang wcums-respiration{at}
  • Accepted 7 August 2008


Objective To determine whether steroids are effective in preventing laryngeal oedema after extubation and reducing the need for subsequent reintubation in critically ill adults.

Design Meta-analysis.

Data sources PubMed, Cochrane Controlled Trials Register, Web of Science, and Embase with no limitation on language, study year, or publication status.

Selection criteria Randomised placebo controlled trials in which parenteral steroids were compared with placebo for preventing complications after extubation in adults.

Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality, independently performed in duplicate. Odds ratios with 95% confidence intervals, risk difference, and number needed to treat were calculated and pooled.

Main outcome measures Primary outcome: laryngeal oedema after extubation. Secondary outcome: subsequent reintubation because of laryngeal oedema.

Results Six trials (n=1923) were identified. Compared with placebo, steroids given before planned extubation decreased the odds ratio for laryngeal oedema (0.38, 95% confidence interval 0.17 to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58), corresponding with 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 multidose regimen of steroids had marked positive effects on the occurrence of laryngeal oedema (0.14; 0.08 to 0.23) and on the rate of subsequent reintubation (0.19; 0.07 to 0.50), with a risk difference of −0.19 (−0.24 to −0.15; 5) and −0.04 (−0.07 to −0.02; 25). In single doses there was only a trend towards benefit, with the confidence interval including 1. Side effects related to steroids were not found.

Conclusion Prophylactic administration of steroids in multidose regimens before planned extubation reduces the incidence of laryngeal oedema after extubation and the consequent reintubation rate in adults, with few adverse events.


  • We thank Gu Jun at Technology Consulting Group of the National Library of China for help with literature searching and Guanjian Liu at the Chinese Cochrane Centre for his statistical assistance.

  • Contributors: GW was responsible for conception and design. TF, GW, and YZ searched for and retrieved articles and extracted and analysed data. TF, GW, BM, ZX, and LW were responsible for interpretation. TF and GQ wrote the manuscript, and GW and YZ revised it. GW and SY provided clinical expertise. GW is guarantor.

  • Funding: This work was supported by West China Hospital, Sichuan University, grant No 141070062.

  • Competing interests: None declared.

  • Ethical approval: Not required.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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