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Use of Dexamethasone to Prevent Extubation Failure in Pediatric Intensive Care Unit: A Randomized Controlled Clinical Trial.地塞米松用于预防儿科重症监护病房拔管失败：一项随机对照临床试验。
J Pediatr Intensive Care. 2020 Nov 3;11(1):41-47. doi: 10.1055/s-0040-1719044. eCollection 2022 Mar.
2
Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults.用于预防和治疗新生儿、儿童及成人拔管后喘鸣的皮质类固醇。
Cochrane Database Syst Rev. 2009 Jul 8;2009(3):CD001000. doi: 10.1002/14651858.CD001000.pub3.
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Dexamethasone in Prevention of Postextubation Stridor in Ventilated Children: A Randomized, Double-blinded, Placebo-controlled Trial.地塞米松预防通气儿童拔管后喘鸣：一项随机、双盲、安慰剂对照试验
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Rate of reintubation in mechanically ventilated neurosurgical and neurologic patients: evaluation of a systematic approach to weaning and extubation.机械通气的神经外科和神经科患者的再插管率：对一种系统的撤机和拔管方法的评估。
Crit Care Med. 2008 Nov;36(11):2986-92. doi: 10.1097/CCM.0b013e31818b35f2.
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Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults.用于预防和治疗新生儿、儿童及成人拔管后喘鸣的皮质类固醇。
Cochrane Database Syst Rev. 2008 Apr 16(2):CD001000. doi: 10.1002/14651858.CD001000.pub2.
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Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial.低危患者拔管后使用高流量鼻导管与常规氧疗对再插管的影响：一项随机临床试验。
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Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial.高风险患者拔管后使用高流量鼻导管与无创通气对再插管和拔管后呼吸衰竭的影响：一项随机临床试验。
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Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study.脱机后意外拔管及重新插管对重症监护病房医院获得性肺炎风险的影响：一项前瞻性多中心研究
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Experience with intubated patients does not affect the accidental extubation rate in pediatric intensive care units and intensive care nurseries.在儿科重症监护病房和重症监护病房中，对插管患者的经验并不影响意外拔管率。
Pediatr Pulmonol. 1997 Jun;23(6):424-8. doi: 10.1002/(sici)1099-0496(199706)23:6<424::aid-ppul5>3.0.co;2-i.

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Fitness checklist model for spontaneous breathing tests in pediatrics.儿科自主呼吸试验的健康检查表模型。
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Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document.执行摘要：儿科呼吸机撤离国际临床实践指南，儿科急性肺损伤和脓毒症研究人员（PALISI）网络文件。
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Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children.多中心随机临床试验比较地塞米松与安慰剂在预防危重症儿童拔管后上呼吸道梗阻中的作用。
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本文引用的文献

1
Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults: A Systematic Review and Meta-analysis.预防性使用皮质类固醇预防成人拔管后喘鸣和再次插管：一项系统评价和荟萃分析。
Chest. 2017 May;151(5):1002-1010. doi: 10.1016/j.chest.2017.02.017. Epub 2017 Feb 21.
2
Treatment of upper airway oedema prior to extubation.拔管前对上呼吸道水肿的治疗。
Indian J Anaesth. 2016 Oct;60(10):777-778. doi: 10.4103/0019-5049.191703.
3
Efficacy of noninvasive mechanical ventilation in prevention of intubation and reintubation in the pediatric intensive care unit.无创机械通气在儿科重症监护病房预防气管插管及再次插管中的疗效
J Crit Care. 2016 Apr;32:175-81. doi: 10.1016/j.jcrc.2015.12.013. Epub 2015 Dec 21.
4
Risk factors for post-extubation stridor in children: the role of orotracheal cannula.儿童拔管后喘鸣的危险因素：口气管插管的作用。
Einstein (Sao Paulo). 2015 Apr-Jun;13(2):226-31. doi: 10.1590/S1679-45082015AO3255. Epub 2015 Jun 9.
5
Comparison between noninvasive mechanical ventilation and standard oxygen therapy in children up to 3 years old with respiratory failure after extubation: a pilot prospective randomized clinical study.3岁以下儿童拔管后呼吸衰竭时无创机械通气与标准氧疗的比较：一项前瞻性随机临床试验研究
Pediatr Crit Care Med. 2015 Feb;16(2):124-30. doi: 10.1097/PCC.0000000000000309.
6
[Post cardiac surgery In children: extubation failure predictor's].[儿童心脏手术后：拔管失败的预测因素]
Rev Bras Ter Intensiva. 2008 Mar;20(1):57-62.
7
Lack of accuracy of ventilatory indexes in predicting extubation success in children submitted to mechanical ventilation.机械通气患儿中通气指标预测拔管成功的准确性欠佳。
Rev Bras Ter Intensiva. 2011 Jun;23(2):199-206.
8
Dexamethasone pretreatment for 24 h versus 6 h for prevention of postextubation airway obstruction in children: a randomized double-blind trial.地塞米松预处理 24 h 与 6 h 预防儿童拔管后气道阻塞的随机双盲试验。
Intensive Care Med. 2014 Sep;40(9):1285-94. doi: 10.1007/s00134-014-3358-9. Epub 2014 Jun 18.
9
[Predictors of extubation failure and reintubation in newborn infants subjected to mechanical ventilation].[接受机械通气的新生儿拔管失败和再次插管的预测因素]
Rev Bras Ter Intensiva. 2014 Jan-Mar;26(1):51-6. doi: 10.5935/0103-507x.20140008.
10
Non-invasive ventilation on a pediatric intensive care unit: feasibility, efficacy, and predictors of success.儿科重症监护病房的无创通气：可行性、疗效和成功预测因素。
Pediatr Pulmonol. 2011 Nov;46(11):1114-20. doi: 10.1002/ppul.21482. Epub 2011 May 26.

地塞米松用于预防儿科重症监护病房拔管失败：一项随机对照临床试验。

Use of Dexamethasone to Prevent Extubation Failure in Pediatric Intensive Care Unit: A Randomized Controlled Clinical Trial.

作者信息

Carvalho Haroldo Teófilo de, Fioretto José Roberto, Bonatto Rossano Cesar, Ribeiro Cristiane Franco, Martin Joelma Gonçalves, Carpi Mário Ferreira

机构信息

Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil.

出版信息

J Pediatr Intensive Care. 2020 Nov 3;11(1):41-47. doi: 10.1055/s-0040-1719044. eCollection 2022 Mar.

DOI:10.1055/s-0040-1719044
PMID:35178277
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8843376/
Abstract

Extubation failure is a common event in intensive care units. Corticosteroids are effective in preventing failure in adults, but no consensus has been reached on this matter in pediatrics. We assessed the efficacy of intravenous dexamethasone in mechanically ventilated children and adolescents for more than 48 hours, with at least one risk factor for failure. Extubations were scheduled 24 hours in advance when possible, and patients were randomly assigned into two groups: one group received a loading dose followed by up to four doses of dexamethasone, and the other group received no corticosteroids. Need for reintubation and length of stay in the pediatric intensive care unit were similar in both groups, and frequency of reintubation was 12.9%.

摘要

拔管失败在重症监护病房是常见事件。皮质类固醇对预防成人拔管失败有效，但在儿科对此问题尚未达成共识。我们评估了静脉注射地塞米松对机械通气超过48小时且至少有一项拔管失败风险因素的儿童和青少年的疗效。尽可能提前24小时安排拔管，患者被随机分为两组：一组接受负荷剂量，随后最多接受四剂地塞米松，另一组不接受皮质类固醇。两组在儿科重症监护病房的再插管需求和住院时间相似，再插管频率为12.9%。