Intubation, Care of intubated patients, Extubation and Outcome
Parameters
Baseline clinical characteristics were recorded as per our previous
trial 1. Patients were intubated by oro-tracheal route
in Pediatric Emergency Room, Children wards or PICU by the on-duty
Pediatric Junior Resident, Pediatric Senior Resident or Pediatric
Critical Care Fellow. Care of intubated patients, elective extubation,
post-extubation monitoring and management was done as per our published
protocol [. Patient ventilated on Hamilton G-5® ventilator during the
study period. Over the last few years, we established a protocol to
actively manage fluid overload with continuous furosemide infusion
(0.05-0.1 mg/Kg/h) after hemodynamic stabilization, especially prior to
extubation. Sometimes, children received albumin as well to get rid of
fluid overload. Duration and intensity of diuresis, and optimization of
fluid de-resuscitation were decided by the treating team. Peritubal leak
was not considered while taking decision for extubation. Patients were
monitored for 24 hours post-extubation for development of PEAO
[defined as a Westley’s Croup Score (WCS) of > 4]13 and/or need for reintubation due to PEAO (WCS> 7). Presence of PEAO based on WCS and need for
re-intubation for PEAO were assessed by minimum of two clinicians (one
pediatric Junior Resident and one Pediatric Critical Care Fellow), which
was then managed with adrenaline nebulization and/or re-intubation.
Treatment safety was assessed for occurrence of upper gastrointestinal
bleeding, hyperglycemia, hypertension and infection for 5 days after
last dose of dexamethasone. Dexamethasone was discontinued if any
contraindication developed during the study, and patient was excluded.
The outcome parameters evaluated were as in our previous trial1