extubation, steroid, post-extubation stridor
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
INTRODUCTION：Stridor and laryngeal edema are two main problems for removal of endotracheal tube of intensive care unit patients. Re-intubation causes further complications such as prolong days of hospitalization, increase infections rates etc. According to some research papers, removal of endotracheal tube of those patients who had been intubated for more than 24 hours will easily cause laryngeal edema. Medical physicians would give steroid either 30 minutes prior removal of endotracheal tube or one day of steroid then remove next day in attempt to prevent laryngeal edema. But it is still controversial to use prophylactic steroid therapy to reduce the occurrence of postextubation laryngeal edema cause by removal of endotracheal tube. The purpose of this study was to ascertain whether administration of single doses of dexamethasone to critically ill, intubated patients reduces or prevents the occurrence of postextubation airway obstruction.
METHODS: We use the five steps of EBN to Appraisal the literature. Find the single dose of Hydrocortisone before extubation cannot improve postextubation laryngeal edema and prevent the occurrence of stridor, cuff-leak test should alert the clinician of a high risk of upper airway obstruction. Cohorts of 108 translaryngeal intubated patients in the medical intensive care unit (ICU) were enrolled. A cuff leak test was conducted before extubation. If positive cuff-leak test were intravenously given 100mgs of Hydrocortisone every 6 hours for one day. The clinical response and cuff-leak volume before and after steroid treatment were gathered for analysis.
RESULTS: The incidence of postextubation stridor was 7.41% (8/108). No one with stridor needed reintubation. Overall, 100% of patients (8/8) with postextubation stridor improved with steroid treatment.
CONCLUSIONS: A cuff-leak test should alert a high risk of upper airway obstruction and Prophylactic administration of multiple-dose dexamethasone is effective in reducing the incidence of postextubation stridor for postextubation laryngeal edema.