Meade M O, Guyatt G H, Cook D J, Sinuff T, Butler R
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Chest. 2001 Dec;120(6 Suppl):464S-8S. doi: 10.1378/chest.120.6_suppl.464s.
We identified three randomized controlled trials (RCTs) that addressed whether preextubation steroid administration reduces postextubation complications in children. The pooled analysis of primary extubation in children demonstrated significantly less stridor (relative risk [RR], 0.57; 95% confidence interval [CI], 0.40 to 0.81) and a trend toward less reintubation (RR, 0.50; 95% CI, 0.02 to 13.87) with corticosteroids. One non-RCT in children who had failed extubation the first time found a significant reduction in duration of prolonged reintubation (> or = 6 days) and in failed reextubations. The four RCTs in adults reported very low reintubation rates, and no conclusions can be drawn. Only one RCT assessed postextubation stridor and found little difference. Overall, we found that corticosteroids decreased the risk of postextubation stridor in children by about 40%. However, the effect of corticosteroids in children and adults to reduce postextubation complications such as reintubation is uncertain.
我们确定了三项随机对照试验（RCT），这些试验探讨了拔管前给予类固醇是否能减少儿童拔管后的并发症。对儿童初次拔管的汇总分析表明，使用皮质类固醇后，喘鸣明显减少（相对风险[RR]，0.57；95%置信区间[CI]，0.40至0.81），再次插管的趋势也有所减少（RR，0.50；95%CI，0.02至13.87）。一项针对首次拔管失败儿童的非随机对照试验发现，再次长时间插管（≥6天）的持续时间和再次拔管失败的情况显著减少。四项针对成人的随机对照试验报告的再次插管率非常低，无法得出结论。只有一项随机对照试验评估了拔管后喘鸣情况，发现差异不大。总体而言，我们发现皮质类固醇可使儿童拔管后喘鸣的风险降低约40%。然而，皮质类固醇对儿童和成人减少再次插管等拔管后并发症的效果尚不确定。
