外傷と救急治療 オープンアクセス

抽象的な

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

Shaikh N, Mehesry T, Hussain G, Chanda A, Belkhair A, Sheikh S, Malmstrom F and Marcus AE

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.

Results: A total of 489 patients were enrolled in the study, 63 were excluded. Methylprednisolone was the most frequently (49.3%) used steroid. Majority of patients (80.1%) were male. Those patients who did not receive a steroid before extubation had a higher percentage of both post extubation stridor and reintubation (p<0.05). Reintubation was more common in male, young patients, severe brain injury patients and patients with higher severity of the disease.

Conclusion: Steroids can prevent post extubation laryngeal edema and subsequently prevent extubation failure. Extubation failure was more commonly occured in male, young, severely ill and severe brain injury patients.