In this episode, I’ll discuss what dose of steroids can prevent post-extubation stridor.
Corticosteroid administration before elective extubation has been used to prevent post-extubation stridor and reintubation.
Multiple steroid regimens have been studied to prevent post-extubation stridor and re-intubation. No one regimen has been proven superior. Three example regimens are:
1. Dexamethasone 5 mg IV q6 hours x 4 doses the day prior to extubation
2. Methylprednisolone 20 mg IV q4 hours x 4 doses prior to extubation
3. Methylprednisolone 40 mg IV once 4 hours prior to extubation
The authors of a recent meta-analysis concluded:
Administration of prophylactic corticosteroids before elective extubation was associated with significant reductions in the incidence of post-extubation airway events and reintubation, with few adverse events. It is reasonable to select patients at high risk for airway obstruction who may benefit from prophylactic corticosteroids.
The risk ratio in this meta-analysis for post-extubation airway events and reintubation with steroid use was 0.42.
Get my 6 tips for pharmacists responding to codes in my free download area at pharmacyjoe.com/free. It’s download #16 on the list.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.