DO CORTICOSTEROIDS PREVENT EXTUBATION FAILURE?

EXTUBATION FAILURE MEANS, THE NEED FOR REINTUBATION SOON AFTER EXTUBATION, IS ASSOCIATED WITH SIGNIFICANT MORTALITY IN ICU PATIENTS.

THE COMMON CAUSES BEING RESIDUAL NEURO MUSCULAR BLOCKADE, RESIDUAL SEDATION OR NARCOSIS,LARYNGOSPASM, LARYNGEAL EDEMA DUE TO PROLONGED MECHANICAL VENTILATION, HEMODYNAMIC INSTABILITY AND VOCAL CORD PALSY. IT IS PROVEN THAT CORTICOSTEROIDS CAN REDUCE AIRWAY INFLAMMATION AND LARYNGEAL EDEMA AND SUBSEQUENTLY REDUCE THE RATE OF RE INTUBATION, BUT WHAT REGIMEN TO BE USED, THROUGH WHICH ROUTE, AND HOW MANY HOURS BEFORE EXTUBATION ETC. STILL REMAIN UNCLEAR



REVIEWING THE STUDY MADE BY MC. CAFFERY ET AL (JOURNAL OF INTENSIVE CARE MEDICINE, VOL 35, NO, 6, JUNE 2009), STEROIDS HELP TO REDUCE THE RATE OF EXTUBATION FAILURE, MAINLY DUE TO A REDUCTION IN LARYNGEAL EDEMA, ESPECIALLY IN PATIENTS UNDERGONE PROLONGED MECHANICAL VENTILATION. ALSO THE EFFECTS OF STEROIDS MAY BE MORE PRONOUNCED WHEN THE TREATMENT IS COMMENCED 12 HRS PRIOR TO EXTUBATION. IN NEONATAL AND PEDIATRIC POPULATIONS DEXAMETHASONE AT DOSES OF 0.25 TO 0.5 MG/KG IS SUGGESTED. BUT FOR ADULTS DIFFERENT REGIMENS ARE PROPOSED. DEXAMETHASONE 8 MG 1 HR PRIOR FOR PATIENTS VENTILATED FOR LESS THAN 36 HRS, IS FOUND TO BE EFFECTIVE. ALSO DEXAMETHASONE 5 MG 24 HRS PRIOR TO EXTUBATION IN 6 DIVIDED DOSES AND CONTINUED POST EXTUBATION FOR ANOTHER 24 HRS, FOR A DURATION OF MECHANICAL VENTILATION OF 7-8 DAYS. OR HYDROCORTISONE 100 MG 1 HR PRIOR, FOR PATIENTS VENTILATED LESS THAN 5 DAYS, ARE FOUND TO BE EFFECTIVE.