Study Participants
Study was performed in a 15-bed PICU over a period of 26 months (February 2017 to March 2019) in a lower-middle income country. PICU is part of a 1740 multi-specialty tertiary care teaching hospital (annual admission, ~ 23,000), and admits~ 950 and ventilates ~ 400 patients per year. Parents or legal guardians gave written informed consent before enrollment into the study. Eligibility criteria included age >3 months and < 12 years, intubation for > 48h, and anticipated to have their first planned extubation during next 24h as in our previous study1. Patients with actual or potential poor airway reflexes, Glasgow Coma Score (GCS) < 8, pre-existing airway issues, previous tracheal intubation or tracheostomy, chronic lung disease, contraindications for steroid, gastrointestinal bleeding, hypertension (>95th centile), hyperglycemia, steroid or chronic NSAID therapy were excluded. Patients were also excluded if their extubation was deferred or they got self-extubated.