Varghese Anjali R, Kambagiri Pratyusha, Sahoo Manas R, Jindal Atul, Goel Anil K
Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Indian J Crit Care Med. 2024 Nov;28(11):1063-1068. doi: 10.5005/jp-journals-10071-24830. Epub 2024 Oct 30.
To study the efficacy of intravenous dexamethasone in preventing postextubation airway obstruction (PEAO).
A double-blinded randomized controlled trial.
The study was conducted in level 3 PICU at AIIMS, Raipur, India, from December 2019 to September 2022.
Children requiring intubation for at least 24 hours and not beyond 14 days were included. Children with upper airway anomalies or who received corticosteroids within the last 7 days were excluded.
The children who satisfied the inclusion criteria were randomized into dexamethasone or placebo group by stratified variable block randomization. Dexamethasone (0.5 mg/kg/dose) or placebo was given four doses (-12 hr., -6 hr., 0 hr., and 6 hr. of extubation).
The occurrence of any clinically significant stridor (Westley stridor score ≥3) was the primary outcome.
Of the seventy ( = 70) children included in the study, 35 received dexamethasone while 35 received placebo. Westley stridor score ≥3 was present in 25.71% ( = 9) in dexamethasone group vs 31.42% ( = 11) in placebo ( = 0.792). Reintubation occurred in 14.28% ( = 10/70) patients, 11.42% (4/35) in dexamethasone group, and 17.14% (6/35) in placebo group ( = 0.734). Five children in the dexamethasone group and six in placebo group died ( = 1.00). There was no difference in the length of PICU stay ( = 0.84) and hospital stay ( = 0.75) among both the groups.
Administration of multiple doses of dexamethasone may not help in the prevention of reintubation but may help in the reducing the incidence of clinically significant stridor.
Varghese AR, Kambagiri P, Sahoo MR, Jindal A, Goel AK. Role of Intravenous Dexamethasone in Prevention of Postextubation Airway Obstruction in Mechanically Ventilated Children in Pediatric Intensive Care Unit: A Double-blind Randomized Controlled Trial. Indian J Crit Care Med 2024;28(11):1063-1068.
研究静脉注射地塞米松预防拔管后气道梗阻（PEAO）的疗效。
双盲随机对照试验。
该研究于2019年12月至2022年9月在印度赖布尔全印医学科学研究所三级儿科重症监护病房（PICU）进行。
纳入至少需要插管24小时且不超过14天的儿童。排除上气道异常或在过去7天内接受过皮质类固醇治疗的儿童。
符合纳入标准的儿童通过分层变量区组随机化分为地塞米松组或安慰剂组。地塞米松（0.5mg/kg/剂量）或安慰剂在拔管前12小时、6小时、0小时和拔管后6小时各给药一次。
任何具有临床意义的喘鸣（韦氏喘鸣评分≥3）的发生情况为主要观察指标。
该研究纳入的70名儿童中，35名接受地塞米松治疗，35名接受安慰剂治疗。地塞米松组中25.71%（9例）出现韦氏喘鸣评分≥3，而安慰剂组为31.42%（11例）（P = 0.792）。14.28%（10/70）的患者需要再次插管，地塞米松组为11.42%（4/35），安慰剂组为17.14%（6/35）（P = 0.734）。地塞米松组5名儿童和安慰剂组6名儿童死亡（P = 1.00）。两组在PICU住院时间（P = 0.84）和住院总时间（P = 0.75）方面无差异。
多次给予地塞米松可能无助于预防再次插管，但可能有助于降低具有临床意义的喘鸣发生率。
Varghese AR, Kambagiri P, Sahoo MR, Jindal A, Goel AK. 静脉注射地塞米松在儿科重症监护病房机械通气儿童预防拔管后气道梗阻中的作用：一项双盲随机对照试验。《印度重症监护医学杂志》2024;28(11):1063 - 1068。
