Dexamethasone versus placebo to prevent re-intubation and post-extubation stridor in children: a systematic review

Abstract

OBJECTIVE

To identify the efficacy of dexamethasone for prevention of re-intubation and post-extubation stridor in children.

METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Clinicaltrials.gov, ScienceDirect, Scopus, Google scholar by using search strategies. The titles and abstracts of relevant articles including children between 4 weeks and 18 years of age requiring airway intubation at least 24 hours and reintubation as primary outcome were individually screened from four reviewers. We extensively searched reference lists of those eligible articles for additional relevant studies. The full texts of four included studies were appraised risk of bias and extracted data.

RESULTS

Three randomized controlled trials and one cohort study were included in this systematic reviews with a total of 336 patients; 160 in dexamethasone group and 176 in the placebo group. There was no difference of reintubation rate between dexamethasone and placebo groups (relative risk (RR), 0.49; 95% confidence interval (CI), 0.13 to 1.83; chi-square 9.47; I2=68%; P=0.02). The incidence of postextubation stridor was decreased in dexamethasone group (RR, 0.57; 95% CI, 0.41 to 0.78; chi-square 3.02; I2=1%; P=0.39).

CONCLUSION

Dexamethasone did not prevent reintubation in children. However, our conclusion was based on 336 patients, high heterogeneity of the included studies and possibility of publication bias. A larger randomized controlled trial is suggested.