Methylprednisolone

Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials Tao Fan, medical student,1 Gang Wang, associate professor and respiratory physician,1 Bing Mao, associate professor and respiratory physician,1 Zeyu Xiong, research associate,2 Yu Zhang, critical care physician,3 Xuemei Liu, research associate,4 Lei Wang, respiratory physician,1 and Sai Yang, respiratory and critical care physician5

 Endotracheal intubation can result in laryngeal oedema; after the tube is removed this might lead to subsequent reintubation Controversy exists regarding the prophylactic administration of steroids to prevent laryngeal oedema and reintubation in adults What this study adds Prophylactic administration of steroids before planned extubation reduces the incidence of laryngeal oedema after extubation and the consequent reintubation rate in adults

Indian J Anaesth. 2009 August; 53(4): 442449. PMCID: PMC2894502 Copyright Indian Journal of Anaesthesia Randomized Comparative Efficacy of Dexamethasone to Prevent Postextubation Upper Airway Complications in Children and Adults in ICU Dinesh Malhotra,1 Showkat Gurcoo,2 Shagufta Qazi,3 and Satyadev Gupta

 The potential benefit of steroids to laryngeal edema is presumably based on its anti-inflammatory actions, which inhibit the release of inflammatory mediators and decrease capillary permeability. The risk of harm from steroid therapy for 24 hours or less to prevent postextubation laryngeal edema is negligible2123 The extent of the effect of prophylactic steroids on airway obstruction is still a matter of some controversy. We conducted this randomized clinical trial to evaluate the effects of prophylactic dexamethasone therapy in preventing latyngealedema for adult patients and children in ICU setting. The choice of dexamethasone was based on its high anti-inflammatory potency, negligible mineral corticoid effects at therapeutic doses, and long duration of action24. We investigated the after-effect until 24 hours after the last dose of dexamethasone.

 We conducted this randomized clinical trial to evaluate the effects of prophylactic dexamethasone therapy in preventing latyngealedema for adult patients and children in ICU setting. The choice of dexamethasone was based on its high anti-inflammatory potency, negligible mineral corticoid effects at therapeutic doses, and long duration of action24. We investigated the after-effect until 24 hours after the last dose of dexamethasone.

 Minerva Anestesiol. 2011 May;77(5):503-9. Methylprednisolone reduces the rates of postextubation stridor and reintubation associated with attenuated cytokine responses in critically ill patients. Cheng KC, Chen CM, Tan CK, Chen HM, Lu CL, Zhang H. Source Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.

 A single injection of methylprednisolone at the dose used 4 h prior to planned extubation effectively reduced the incidence of PES and the reintubation rate. These beneficial effects were associated with the up-regulation of IL-4 and IL-10 and the down-regulation of IL-6 and IL-8 in the critically ill adult patients