Thursday 05, Nov 2009
Early Steroid usage in high-risk patients can minimize stridor and reintubation
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The risk of stridor and reintubation in selected high-risk patients can be minimized to a considerable extent by administering steroids at least four hours before extubation, as per a recent report.
Dr. Samir Jaber from University of Montpellier I in France and colleagues conducted a quantitative meta-analysis of seven studies for identifying the effectiveness of prophylactic steroid therapy in inhibiting reintubation and post-extubation stridor. It is noteworthy to remember that this identification process took the at-risk populations and steroid administration regimen into account.
It was suggested during the study that the prophylactic steroid therapy is still controversial in both selected and non-selected patients when it comes to preventing post-extubation stridor and reintubation.
From Medscape.com:
Administration of steroids at least 4 hours before planned extubation significantly reduced the risk for reintubation, but not for stridor, the researchers note, and later administration of steroids did not decrease the risk for reintubation or stridor.
The investigators conclude: “The present meta-analysis suggests, first that the beneficial effect of steroids to prevent post-extubation stridor and reintubation were observed in the subgroup of patients with a high risk to develop post-extubation stridor, as identified by the cuff-leak test, and second that steroid treatment before a planned extubation decreases the risk of reintubation only if intravenous steroid administration was performed at least 4 hours before planned extubation.”
“The benefit of steroid remains unclear when patients are not selected,” they conclude.
It was indicated during the study that reintubation risk in trials enrolling high-risk patients was minimized with steroid treatment but the minimized risk was not well-defined when the conducted trials did not select patients for reintubation risk.
Tags: extubation, prophylactic steroid therapy, reintubation, steroid administration regimen, steroid treatment, stridor
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