Dexamethasone and the Prevention of Post-Extubation Airway Obstruction in Adults
Status:
Unknown status
Trial end date:
2007-07-01
Target enrollment:
Participant gender:
Summary
Laryngotracheal injury related to intubation may cause narrowing of the airway due to edema
of the glottis. Post-extubation airway frequently necessitating re-intubation and resulting
in the prolongation of intensive care. Factors correlating with the development of
post-extubation stridor include age, female gender, an elevated Acute Physiologic and Chronic
Health Evaluation II, trauma related to endotracheal intubation, excessive ETT size,
unnecessary tube mobility, increased cuff pressure, frequent tracheal aspirations, infection,
arterial hypotension, and a prolonged intubation period. Because the presence of an
endotracheal tube (ETT) precludes direct visualization of the upper airway, recognition of
edema due to laryngotracheal injury is often difficult. However, upper airway patency may be
measured indirectly in the intubated patient by documentation of a leak around the ETT upon
deflation of the sealing balloon cuff encircling the ETT. Controversy currently exists
regarding the effectiveness of prophylactic steroid therapy for patients considered at high
risk for post-extubation stridor. Only a limited number of prospective trials involving
adults and evaluating the benefits of corticosteroid therapy prior to extubation have been
conducted.
Studies regarding the efficacy of prophylactic corticosteroids for intubated patients have
yielded conflicting results due to differences in the number of doses or types of
corticosteroids administered.
The present study was conducted to evaluate the effects of prophylactic dexamethasone therapy
for a subset of high-risk patients who had been intubated for > 48 hours and who were
undergoing their first elective extubation in an ICU setting. The specific objectives were to
determine whether multiple doses of dexamethasone are effective in the reduction or
prevention of post-extubation airway obstruction in patients with a cuff leak volume (CLV) <
110 mL and to ascertain whether an aftereffect follows the discontinuation of dexamethasone.