Tan N, Li K C, Qian S Y
Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Zhonghua Yi Xue Za Zhi. 2025 Apr 15;105(15):1184-1190. doi: 10.3760/cma.j.cn112137-20241212-02520.
To evaluate the efficacy of systemic glucocorticoid (GC) on preventing postextubation upper airway obstruction (UAO) in children. Clinical data were retrospectively collected from the children with an intubation duration of ≥48 hours in the Department of Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital, Capital Medical University, from January 1, 2021 to December 31, 2021. The patients were divided into the GC-using group and the non-GC-using group according to whether systemic GC was used within 24 hours before extubation. The incidence of postextubation UAO and extubation failure were compared between the two groups. GC-related adverse effects were recorded. Additionally, the effects of systemic GC administration within 24 hours before extubation on postextubation UAO and extubation failure were evaluated. Multivariable logistic regression analysis was performed to determine the infiuencing factors for postextubation UAO and extubation failure. To further assess the impact of systemic GC administration within 24 hours before extubation on postextubation UAO, subgroup analyses were conducted based on patient characteristics that could influence GC efficacy, including sex, age, intubation reason, and intubation duration. A total of 206 children were enrolled. There were 109 cases in the GC-using group, including 65 males and 44 females, age [ (, )] was 32 (12, 87) months. There were 97 in the non-GC-using group, including 70 males and 27 females, aged 26 (7, 86) months. The incidence of postextubation UAO [17.4% (19/109) vs 36.1% (35/97), =0.002] and extubation failure [2.8% (3/109) vs 11.3% (11/97), =0.015] was lower in the GC-using group compared with the non-GC-using group. The most common GC-related adverse effect was new-onset infections (15.6%, 17/109), followed by upper gastrointestinal bleeding (6.4%, 7/109), hyperglycemia (5.5%, 6/109), and hypertension (2.8%, 3/109). Multivariable logistic regression analysis showed that systemic GC use within 24 hours before extubation was negatively associated with postextubation UAO (=0.386, 95%: 0.198-0.753) and extubation failure (=0.234, 95%: 0.063-0.871). Subgroup analysis showed that the efficacy of using systemic GC within 24 hours before extubation in reducing postextubation UAO incidence was not influenced by sex, age, intubation reason or intubation duration (all >0.05). Systemic GC may be effective in preventing postextubation UAO in children.
评估全身应用糖皮质激素（GC）预防儿童拔管后上气道梗阻（UAO）的疗效。回顾性收集2021年1月1日至2021年12月31日首都医科大学附属北京儿童医院儿科重症监护病房（PICU）中插管时间≥48小时的儿童的临床资料。根据拔管前24小时内是否使用全身GC将患者分为GC使用组和非GC使用组。比较两组拔管后UAO的发生率和拔管失败率。记录GC相关的不良反应。此外，评估拔管前24小时内全身应用GC对拔管后UAO和拔管失败的影响。进行多变量逻辑回归分析以确定拔管后UAO和拔管失败的影响因素。为进一步评估拔管前24小时内全身应用GC对拔管后UAO的影响，根据可能影响GC疗效的患者特征进行亚组分析，包括性别、年龄、插管原因和插管时间。共纳入206例儿童。GC使用组109例，其中男性65例，女性44例，年龄[（，）]为32（12，87）个月。非GC使用组97例，其中男性70例，女性27例，年龄26（7，86）个月。GC使用组拔管后UAO的发生率[17.4%（19/109）对36.1%（35/97），=0.002]和拔管失败率[2.8%（3/109）对11.3%（11/97），=0.015]低于非GC使用组。最常见的GC相关不良反应是新发感染（15.6%，17/109），其次是上消化道出血（6.4%，7/109）、高血糖（5.5%，6/109）和高血压（2.8%，3/109）。多变量逻辑回归分析显示，拔管前24小时内使用全身GC与拔管后UAO（=0.386，95%：0.198 - 0.753）和拔管失败（=0.234，95%：0.063 - 0.871）呈负相关。亚组分析显示，拔管前24小时内使用全身GC降低拔管后UAO发生率的疗效不受性别、年龄、插管原因或插管时间的影响（均>0.05）。全身应用GC可能对预防儿童拔管后UAO有效。
