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