Information de reference pour ce titreAccession Number: | 00003246-200605000-00008.
|
Author: | Cheng, Kuo-Chen MD; Hou, Ching-Cheng MD; Huang, Heng-Ching MD; Lin, Shu-Chih RRT; Zhang, Haibo MD, PhD
|
Institution: | From the Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan (K-CC, H-CH); Department of Medicine, National Defense Medical Center, Taipei, Taiwan (K-CC); Department of Intensive Care Medicine, Chi Mei Hospital, Liouying, Taiwan (C-CH); and Department of Anaesthesia, Interdepartmental Division of Critical Care Medicine, Department of Physiology, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada (HZ).
|
Title: | |
Source: | Critical Care Medicine. 34(5):1345-1350, May 2006.
|
Abstract: | Objective: To determine whether treatment with corticosteroids decreases the incidence of postextubation airway obstruction in an adult intensive care unit.
Design: Clinical experiment.
Setting: Adult medical and surgical intensive care unit of a teaching hospital.
Patients: One hundred twenty-eight patients who were intubated for >24 hrs with a cuff leak volume <24% of tidal volume and met weaning criteria.
Interventions: Patients were randomized into a placebo group (control, n = 43) receiving four injections of normal saline every 6 hrs, a 4INJ group (n = 42) receiving four injections of methylprednisolone sodium succinate, or a 1INJ group (n = 42) receiving one injection of the corticosteroid followed by three injections of normal saline. Cuff volume was assessed 1 hr after each injection, and extubation was performed 1 hr after the last injection. Postextubation stridor was confirmed by examination using bronchoscopy or laryngoscopy.
Measurements and Main Results: The incidences of postextubation stridor were lower both in the 1INJ and the 4INJ groups than in the control group (11.6% and 7.1% vs. 30.2%, both p < .05), whereas there was no difference between the two treated groups (p = .46). The cuff leak volume increased after the second and fourth injection in the 4INJ group and after a second injection in the 1INJ group compared with the control group (both p < .05).
Conclusions: A reduced cuff leak volume is a reliable indicator to identify patients at high risk to develop stridor. Treatment with a single or multiple injections of methylprednisolone can effectively reduce the occurrence of postextubation stridor.
(C) 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins
|
Author Keywords: | endotracheal intubation; cuff-leak test; laryngeal edema; corticosteroids.
|
References: | 1. Natanson C, Shelhamer JH, Parrillo JE: Intubation of the trachea in the critical care setting. JAMA 1985; 253:1160-1165
2. Stauffer JL, Olson DE, Petty TL: Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med 1981; 70:65-76
3. Kastanos N, Estopa Miro R, Marin Perez A, et al: Laryngotracheal injury due to endotracheal intubation: Incidence, evolution, and predisposing factors. A prospective long-term study. Crit Care Med 1983; 11:362-367
4. Ho LI, Harn HJ, Lien TC, et al: Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intensive Care Med 1996; 22:933-936
5. Jaber S, Chanques G, Matecki S, et al: Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med 2003; 29:69-74
6. Epstein SK, Ciubotaru RL: Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998; 158:489-493
7. Demling RH, Read T, Lind LJ, et al: Incidence and morbidity of extubation failure in surgical intensive care patients. Crit Care Med 1988; 16:573-577
8. Marik P: The cuff-leak test as a predictor of postextubation stridor: A prospective study. Respir Care 1996; 41:509-511
9. Sandhu RS, Pasquale MD, Miller K, et al: Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation. J Am Coll Surg 2000; 190:682-687
10. Miller RL, Cole RP: Association between reduced cuff leak volume and postextubation stridor. Chest 1996; 110:1035-1040
11. Fisher MM, Raper RF: The "cuff-leak" test for extubation. Anaesthesia 1992; 47:10-12
12. Darmon JY, Rauss A, Dreyfuss D, et al: Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study. Anesthesiology 1992; 77:245-251
13. Anene O, Meert KL, Uy H, et al: Dexamethasone for the prevention of postextubation airway obstruction: A prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med 1996; 24:1666-1669
14. Daley BJ, Garcia-Perez F, Ross SE: Reintubation as an outcome predictor in trauma patients. Chest 1996; 110:1577-1580
15. Chevron V, Menard JF, Richard JC, et al: Unplanned extubation: Risk factors of development and predictive criteria for reintubation. Crit Care Med 1998; 26:1049-1053
16. Bishop MJ, Weymuller EA Jr, Fink BR: Laryngeal effects of prolonged intubation. Anesth Analg 1984; 63:335-342
17. Bishop MJ: Mechanisms of laryngotracheal injury following prolonged tracheal intubation. Chest 1989; 96:185-186
18. Way WL, Sooy FA: Histologic changes produced by endotracheal intubation. Ann Otol 1965; 74:799-813
19. Demling W, Oech SR: Steroid and antihistaminic therapy for postintubation subglottic edema. Anesthesiology 1961; 22:933-936
20. Haynes RC: Adrenocorticotropic hormones, adrenocortical steroids and their synthetic analogues; inhibitors of the synthesis and actions of adrenocortical hormones. In: The Pharmacological Basis of Therapeutics. Gilman AG, Rall TW, Nies AS (Eds). New York, Pergamon Press, 1990, pp 1431-1462
21. Hawkins DB, Crockett DM, Shum TK: Corticosteroids in airway management. Otolaryngol Head Neck Surg 1983; 91:593-596
22. Goddard JE Jr, Phillips OC, Marcy JH: Betamethasone for prophylaxis of postintubation inflammation. A double-blind study. Anesth Analg 1967; 46:348-353
23. Biller HF, Bone RC, Harvey JE, et al: Laryngeal edema: An experimental study. Ann Otol Rhinol 1970; 174:1084-1087
24. Sivilotti ML, Filbin MR, Murray HE, et al: Does the sedative agent facilitate emergency rapid sequence intubation? Acad Emerg Med 2003; 10:612-620
25. Mencke T, Echternach M, Kleinschmidt S, et al: Laryngeal morbidity and quality of tracheal intubation: A randomized controlled trial. Anesthesiology 2003; 98:1049-1056
26. Gaynor EB, Greenberg SB: Untoward sequelae of prolonged intubation. Laryngoscope 1985; 95:1461-1467
27. Whited RE: A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope 1984; 94:367-377
|
Language: | English.
|
Document Type: | Clinical Investigations.
|
Journal Subset: | Clinical Medicine.
|
ISSN: | 0090-3493
|
NLM Journal Code: | dtf, 0355501
|
DOI Number: | https://dx.doi.org/10.1097/01.CC...- ouverture dans une nouvelle fenêtre
|
Annotation(s) | |
|
|