Markovitz Barry P., Randolph Adrienne G.
Departments of Anesthesiology and Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO; and the Departments of Anesthesia and Pediatrics, Harvard Medical School, The Children's Hospital, Boston, MA.
Pediatr Crit Care Med. 2002 Jul;3(3):223-226. doi: 10.1097/00130478-200207000-00003.
To determine whether corticosteroids are effective in preventing or treating postextubation stridor and in reducing the need for subsequent reintubation of the trachea in critically ill infants and children. DESIGN: Meta-analysis of published randomized controlled trials. DATA SOURCES: References of each trial from a MEDLINE search were reviewed, and experts in the field were contacted. STUDY SELECTION: Any randomized controlled trial comparing the administration of corticosteroids with placebo on the prevalence of reintubation or postextubation stridor in infants or children receiving mechanical ventilation via an endotracheal tube in an intensive care unit. DATA EXTRACTION: Data extraction and methodologic quality assessment were assessed independently by two reviewers. DATA SYNTHESIS: Six controlled clinical trials met the criteria for inclusion; three trials pertain to neonates and three to children. Five trials examined the use of steroids for the prevention of reintubation (four of these evaluated postextubation stridor specifically); one trial examined the use of steroids to treat existing postextubation stridor in children. There was a nonsignificant trend toward a decreased rate of reintubation in all subjects when prophylactic steroids were used (n = 376, relative risk [RR] = 0.34, 95% confidence interval [CI] = 0.05-2.33). Prophylactic use of steroids reduced postextubation stridor in the pooled studies (n = 325, RR = 0.50, 95% CI = 0.28-0.88). In young children, there were significant reductions of postextubation stridor with preventive treatment (n = 216, RR = 0.53, 95% CI = 0.28-0.97), and a trend toward less stridor was observed in neonates (n = 109, RR = 0.42, 95% CI = 0.07-2.32). There was a nonsignificant trend toward a reduced reintubation rate when steroids were used to treat existing upper airway obstruction requiring reintubation (RR = 0.55, 95% CI = 0.17-1.78). Side effects were seldom reported and could not be evaluated. CONCLUSIONS: Prophylactic administration of dexamethasone before elective extubation reduces the prevalence of postextubation stridor in neonates and children and may reduce the rate of reintubation.
确定皮质类固醇在预防或治疗拔管后喘鸣以及减少重症婴幼儿随后气管再次插管需求方面是否有效。
对已发表的随机对照试验进行荟萃分析。
对MEDLINE检索中每项试验的参考文献进行了审查，并联系了该领域的专家。
任何比较皮质类固醇与安慰剂给药对重症监护病房中经气管插管接受机械通气的婴幼儿再次插管发生率或拔管后喘鸣发生率影响的随机对照试验。
由两名审阅者独立进行数据提取和方法学质量评估。
六项对照临床试验符合纳入标准；三项试验涉及新生儿，三项涉及儿童。五项试验研究了类固醇用于预防再次插管的情况（其中四项专门评估了拔管后喘鸣）；一项试验研究了类固醇用于治疗儿童现有的拔管后喘鸣。使用预防性类固醇时，所有受试者的再次插管率有下降趋势但无统计学意义（n = 376，相对危险度[RR] = 0.34，95%置信区间[CI] = 0.05 - 2.33）。在汇总研究中，预防性使用类固醇可降低拔管后喘鸣发生率（n = 325，RR = 0.50，95% CI = 0.28 - 0.88）。在幼儿中，预防性治疗可显著降低拔管后喘鸣发生率（n = 216，RR = 0.53，95% CI = 0.28 - 0.97），在新生儿中观察到喘鸣减少趋势（n = 109，RR = 0.42，95% CI = 0.07 - 2.32）。当使用类固醇治疗需要再次插管的现有上呼吸道梗阻时，再次插管率有下降趋势但无统计学意义（RR = 0.55，95% CI = 0.17 - 1.78）。很少报告副作用，无法进行评估。
在择期拔管前预防性给予地塞米松可降低新生儿和儿童拔管后喘鸣的发生率，并可能降低再次插管率。
