Use of Steroid to Prevent Extubation Failure due to Stridor in Surgical Intensive Care Patients


Extubation failure increases morbidity and mortality in intensive care. Laryngeal edema which develops post extubation is one of the major risk factor for extubation failure. Post extubation laryngeal edema occurs in up to 37% of the extubations. Various steroids regiments have been commonly used pre extubation to prevent development of laryngeal edema. Aim of this study was to find type of patients to have frequent extubation failure and whether steroids can prevent post extubation laryngeal edema.

Patients and methods: It was a prospective observational study conducted in a tertiary hospital Surgical Intensive Care Unit (SICU). All patients included in study received either one of the steroid regimes or no steroid. Patients with tracheostomy, pediatric age group, pregnant patients, and patients who were already on steroid therapy were excluded from the study. Data entered in SPSS program, chi-square test was used to compare the variables and a p value of <0.05 was considered as significant.

Extubation is the final stage in liberating patient from invasive mechanical ventilation. Reintubation due to post extubation stridor increases the duration of mechanical ventilation, and contributes to morbidity and mortality in the critically ill patients. Post extubation stridor secondary to the laryngeal edema occurs in up to 37% of extubations and 15% of all reintubations are performed because of post extubation severe laryngeal edema. Post extubation stridor is an accepted marker of laryngeal edema, it is a high pitched sound produced by airflow through the narrowed airway tract.

Ventilator was set in the assist control mode with the patient receiving volume-cycled ventilation with the cuff inflated, displayed inspiratory and expiratory tidal volumes were recorded cuff was deflated and the expiratory tidal volume was recorded over the six breathing cycles as the expiratory tidal volume will reach a plateau value after a few cycles average the three lowest values. The difference between the inspiratory tidal volume (measured before the cuff was deflated) and the averaged expiratory tidal volume (after cuff deflation) is the cuff leak volume. If leak volume is less than 110 mL or 10% of tidal volume as the cut-off value and leak test was considered as negative. These patients received one of the following steroid therapies as per the decision of morning consultant, who was blinded about the study.

Critically ill patients frequently need endotracheal intubation for airway protection and invasive ventilation. The final stage in discountiation of invasive ventilation is the successful tracheal extubation. Failed extubation increases the morbidity and mortality due to prolonged ventilation, increased ventilator associated events and the most significant etiologies of failed extubation is the development of post extubation laryngeal edema.

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