INTRODUCTION
Postextubation airway obstruction (PEAO) is common in pediatric
intensive care units (PICUs) 1-4 and have potential
for re-intubation 1,4,5. Reintubation increases
morbidity, mortality and cost of care. Incidence is higher in
low-resource settings, as children get intubated in emergency and
uncontrolled situations, have multiple airway manipulations and
hypoalbuminemic edema at the time of extubation 1.
Multi-dose pretreatment with systemic steroids seems to prevent PEAO in
at-risk adults 6-10, as well as in children1,5,9. We demonstrated reduction in incidence (82% vs
65%) and severity of PEAO with 24h pretreatment with multi-dose
dexamethasone (0.5 mg/Kg/dose; max, 8 mg/dose; q6h; total of 6 doses)
compared to 6h pre-treatment in a clinical setting with high incidence
of PEAO 1. Though dexamethasone at this dose was safe
in small studies 1,11, there is a potential for
hypertension, upper gastrointestinal bleeding, hyperglycemia, glycosuria
and sepsis 11,12. Hypertension is likely to add to the
autonomic instability observed during iatrogenic withdrawal syndrome.
Suggested dose of dexamethasone for children varies widely from 0.25
mg/Kg/dose to 0.50 mg/Kg/dose 12. Some centers even
use a dose of 0.15 mg/Kg/dose, while many other centers do not use
dexamethasone at all. There is felt need for more evidence to identify
the prophylactic role of dexamethasone 9 and to define
its optimal dose in children 12.
Recently, low dose dexamethasone pretreatment (5 mg/dose, q6h, total of
4 doses) was shown to be equally effective as the high dose (10 mg/dose,
q6h, total of 4 doses) in preventing PEAO among at-risk adult patients
from Taiwan 8. Inspired by these results and lack of
information on optimal dose in children, we conducted this trial to
assess the effectiveness of half of the currently used dose in our unit
(i.e., 0.25 mg/Kg/dose; maximum, 4 mg/dose; q6h; total of 6 doses) in
preventing PEAO. It was a non-funded time-bound dissertation project as
part of the 3-year fellowship program in Pediatric Critical Care, and
was registered with Clinical Trials Registry-India vide registration
number CTRI/2017/08/009273.