Comparison of High- and Low-dose Dexamethasone for Preventing Postextubation Airway Obstruction in Adults: A Prospective, Randomized, Double blind, Placebo-controlled Study

SummaryBackgroundThe study investigated the effectiveness of dexamethasone injections for reducing the occurrence of postextubation airway obstruction (PEAO).MethodsOne hundred and thirty-eight patients who were intubated for ≥ 48 hours with a cuff-leak volume (CLV) < 110 mL were treated with low-dose dexamethasone (5 mg; n = 41), high-dose dexamethasone (10 mg; n = 42), or placebo (normal saline; n = 43) injection every 6 hours for a total of four doses on the day preceding extubation. CLV was measured before the first injection, 1 hour after each injection, and 24 hours after the fourth injection. Extubation was performed 24 hours after the last injection. PEAO was recorded within 48 hours postextubation.ResultsAdministration of dexamethasone resulted in a significant increase in absolute CLV and change of CLV relative to baseline tidal volume occurred (p < 0.05). However, there was no significant difference between the low- and high-dose dexamethasone groups. The incidence of PEAO was 7.1% in the high-dose group, 9.8% in the low-dose group, and 30.2% in the placebo group. The incidence of PEAO differed significantly between the dexamethasone groups and the placebo group (p = 0.001). There was no significant difference in the reintubation rates among the high-dose group (2.1%, 1/42), the low-dose group (2.4%, 1/41), and the placebo group (4.7%, 2/43; p = 0.79).ConclusionProphylactic administration of multiple low-dose dexamethasone is sufficient for reducing the incidence of PEAO in high-risk patients.