Jhamb Urmila
Department of Paediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
Indian J Crit Care Med. 2020 Dec;24(12):1230-1235. doi: 10.5005/jp-journals-10071-23679.
Postextubation stridor (PES) is a serious complication in ventilated patients which increases the length of stay in intensive care units (ICUs). We studied the efficacy of dexamethasone in prevention of PES in ventilated children.
A randomized, double-blinded, placebo-controlled trial was carried out in pediatric ICU. Children (2 months to 12 years) who underwent mechanical ventilation for 48 hours were randomized into two groups to receive either dexamethasone at 0.15 mg/kg/dose or normal saline for 6 doses with first dose given 6-12 hours prior to planned extubation. Patients were hourly monitored for vital signs and appearance of stridor using Westley croup score (WCS) within 72 hours after extubation. Whenever the score exceeded 4, nebulized adrenaline (1:1,000 at 0.5 mL/kg/dose) was given. The primary outcome was occurrence of PES.
Dexamethasone group comprised of 42 children while placebo group had 38 children. Baseline characteristics of two groups were similar. Overall PES occurred in 48.7% patients, 42.8% (18/42) in dexamethasone group, and 55.2% (21/38) in placebo group [ = 0.26, odds ratio (OR) 95% confidence interval (CI) = 0.60 (0.25-1.47)]. WCS >4 was present in 28.5% (12/42) of dexamethasone group vs 47.3% (18/38) of placebo group [ = 0.08, OR (95% CI) = 0.37 (0.12-1.06)]. There was no difference in reintubation rates in two groups [ = 0.9, OR (95% CI) = 1.06 (0.32-3.51)].
We found no beneficial role of the studied dose of dexamethasone (0.15 mg/kg) over placebo on the incidence of PES.
Ritu, Jhamb U. Dexamethasone in Prevention of Postextubation Stridor in Ventilated Children: A Randomized, Double-blinded, Placebo-controlled Trial. Indian J Crit Care Med 2020;24(12):1230-1235.
拔管后喘鸣（PES）是机械通气患者的一种严重并发症，会延长重症监护病房（ICU）的住院时间。我们研究了地塞米松预防机械通气儿童发生PES的疗效。
在儿科ICU进行了一项随机、双盲、安慰剂对照试验。将接受机械通气48小时的2个月至12岁儿童随机分为两组，一组接受0.15mg/kg剂量的地塞米松，另一组接受生理盐水，均为6剂，首剂在计划拔管前6至12小时给予。拔管后72小时内，每小时监测患者的生命体征，并使用韦氏喉炎评分（WCS）评估喘鸣情况。当评分超过4分时，给予雾化肾上腺素（1:1000，0.5mL/kg剂量）。主要结局是PES的发生。
地塞米松组有42名儿童，安慰剂组有38名儿童。两组的基线特征相似。总体而言，48.7%的患者发生了PES，地塞米松组为42.8%（18/42），安慰剂组为55.2%（21/38）[ = 0.26，优势比（OR）95%置信区间（CI） = 0.60（0.25 - 1.47）]。地塞米松组28.5%（12/42）的患者WCS>4，而安慰剂组为47.3%（18/38）[ = 0.08，OR（95%CI） = 0.37（0.12 - 1.06）]。两组的再次插管率无差异[ = 0.9，OR（95%CI） = 1.06（0.32 - 3.51）]。
我们发现，在所研究的地塞米松剂量（0.15mg/kg）下，与安慰剂相比，对PES的发生率没有有益作用。
Ritu，Jhamb U. 地塞米松预防机械通气儿童拔管后喘鸣：一项随机、双盲、安慰剂对照试验。《印度重症监护医学杂志》2020；24（12）：1230 - 1235。
