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Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials.

Fan T, Wang G, Mao B, Xiong Z, Zhang Y, Liu X, Wang L, Yang S - BMJ (2008)

Bottom Line: Meta-analysis.In single doses there was only a trend towards benefit, with the confidence interval including 1.Side effects related to steroids were not found.

View Article: PubMed Central - PubMed

Affiliation: Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.

ABSTRACT

Objective: To determine whether steroids are effective in preventing laryngeal oedema after extubation and reducing the need for subsequent reintubation in critically ill adults.

Design: Meta-analysis.

Data sources: PubMed, Cochrane Controlled Trials Register, Web of Science, and Embase with no limitation on language, study year, or publication status. Selection criteria Randomised placebo controlled trials in which parenteral steroids were compared with placebo for preventing complications after extubation in adults. Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality, independently performed in duplicate. Odds ratios with 95% confidence intervals, risk difference, and number needed to treat were calculated and pooled.

Primary outcome: laryngeal oedema after extubation. Secondary outcome: subsequent reintubation because of laryngeal oedema.

Results: Six trials (n=1923) were identified. Compared with placebo, steroids given before planned extubation decreased the odds ratio for laryngeal oedema (0.38, 95% confidence interval 0.17 to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58), corresponding with a risk difference of -0.10 (-0.12 to -0.07; number needed to treat 10) and -0.02 (-0.04 to -0.01; 50), respectively. Subgroup analyses indicated that a multidose regimen of steroids had marked positive effects on the occurrence of laryngeal oedema (0.14; 0.08 to 0.23) and on the rate of subsequent reintubation (0.19; 0.07 to 0.50), with a risk difference of -0.19 (-0.24 to -0.15; 5) and -0.04 (-0.07 to -0.02; 25). In single doses there was only a trend towards benefit, with the confidence interval including 1. Side effects related to steroids were not found.

Conclusion: Prophylactic administration of steroids in multidose regimens before planned extubation reduces the incidence of laryngeal oedema after extubation and the consequent reintubation rate in adults, with few adverse events.

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Fig 3 Effect of steroids on reintubation after extubation
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fig3: Fig 3 Effect of steroids on reintubation after extubation

Mentions: Table 2 summarises individual study data for the two outcomes. In the individual studies, most of the confidence intervals for the odds ratios for laryngeal oedema and reintubation include 1.0, whereas meta-analysis indicated that prophylactic steroids before planned extubation decreased the likelihood of laryngeal oedema after extubation (odds ratio 0.38; 95% confidence interval 0.17 to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58) (figs 2 and 3) , corresponding with a risk difference of −0.10 (−0.12 to −0.07; number needed to treat 10) and −0.02 (−0.04 to −0.01; 50), respectively. The Q test, however, showed statistical heterogeneity in the occurrence of laryngeal oedema (χ2=19.48, P=0.002, I2=74.3%) but not in the rate of reintubation (χ2=5.76, P=0.33, I2=13.2%). Reanalyses with a random effects model still suggested that the regimen reduced the occurrence of laryngeal oedema (0.38, 0.17 to 0.85), corresponding with a risk difference of −0.10 (−0.20 to 0.00; 10). The funnel plot showed apparent asymmetry in laryngeal oedema and reintubation.


Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials.

Fan T, Wang G, Mao B, Xiong Z, Zhang Y, Liu X, Wang L, Yang S - BMJ (2008)

Fig 3 Effect of steroids on reintubation after extubation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2570741&req=5

fig3: Fig 3 Effect of steroids on reintubation after extubation
Mentions: Table 2 summarises individual study data for the two outcomes. In the individual studies, most of the confidence intervals for the odds ratios for laryngeal oedema and reintubation include 1.0, whereas meta-analysis indicated that prophylactic steroids before planned extubation decreased the likelihood of laryngeal oedema after extubation (odds ratio 0.38; 95% confidence interval 0.17 to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58) (figs 2 and 3) , corresponding with a risk difference of −0.10 (−0.12 to −0.07; number needed to treat 10) and −0.02 (−0.04 to −0.01; 50), respectively. The Q test, however, showed statistical heterogeneity in the occurrence of laryngeal oedema (χ2=19.48, P=0.002, I2=74.3%) but not in the rate of reintubation (χ2=5.76, P=0.33, I2=13.2%). Reanalyses with a random effects model still suggested that the regimen reduced the occurrence of laryngeal oedema (0.38, 0.17 to 0.85), corresponding with a risk difference of −0.10 (−0.20 to 0.00; 10). The funnel plot showed apparent asymmetry in laryngeal oedema and reintubation.

Bottom Line: Meta-analysis.In single doses there was only a trend towards benefit, with the confidence interval including 1.Side effects related to steroids were not found.

View Article: PubMed Central - PubMed

Affiliation: Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.

ABSTRACT

Objective: To determine whether steroids are effective in preventing laryngeal oedema after extubation and reducing the need for subsequent reintubation in critically ill adults.

Design: Meta-analysis.

Data sources: PubMed, Cochrane Controlled Trials Register, Web of Science, and Embase with no limitation on language, study year, or publication status. Selection criteria Randomised placebo controlled trials in which parenteral steroids were compared with placebo for preventing complications after extubation in adults. Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality, independently performed in duplicate. Odds ratios with 95% confidence intervals, risk difference, and number needed to treat were calculated and pooled.

Primary outcome: laryngeal oedema after extubation. Secondary outcome: subsequent reintubation because of laryngeal oedema.

Results: Six trials (n=1923) were identified. Compared with placebo, steroids given before planned extubation decreased the odds ratio for laryngeal oedema (0.38, 95% confidence interval 0.17 to 0.85) and subsequent reintubation (0.29, 0.15 to 0.58), corresponding with a risk difference of -0.10 (-0.12 to -0.07; number needed to treat 10) and -0.02 (-0.04 to -0.01; 50), respectively. Subgroup analyses indicated that a multidose regimen of steroids had marked positive effects on the occurrence of laryngeal oedema (0.14; 0.08 to 0.23) and on the rate of subsequent reintubation (0.19; 0.07 to 0.50), with a risk difference of -0.19 (-0.24 to -0.15; 5) and -0.04 (-0.07 to -0.02; 25). In single doses there was only a trend towards benefit, with the confidence interval including 1. Side effects related to steroids were not found.

Conclusion: Prophylactic administration of steroids in multidose regimens before planned extubation reduces the incidence of laryngeal oedema after extubation and the consequent reintubation rate in adults, with few adverse events.

Show MeSH
Related in: MedlinePlus