Efficacy of systemic glucocorticoids on preventing postextubation upper airway obstruction in children

Objective: To evaluate the efficacy of systemic glucocorticoid (GC) on preventing postextubation upper airway obstruction (UAO) in children.

Methods: Clinical data were retrospectively collected from the children with an intubation duration of ≥48 hours in the Department of Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital, Capital Medical University, from January 1, 2021 to December 31, 2021. The patients were divided into the GC-using group and the non-GC-using group according to whether systemic GC was used within 24 hours before extubation. The incidence of postextubation UAO and extubation failure were compared between the two groups. GC-related adverse effects were recorded. Additionally, the effects of systemic GC administration within 24 hours before extubation on postextubation UAO and extubation failure were evaluated. Multivariable logistic regression analysis was performed to determine the infiuencing factors for postextubation UAO and extubation failure. To further assess the impact of systemic GC administration within 24 hours before extubation on postextubation UAO, subgroup analyses were conducted based on patient characteristics that could influence GC efficacy, including sex, age, intubation reason, and intubation duration.

Results: A total of 206 children were enrolled. There were 109 cases in the GC-using group, including 65 males and 44 females, age [M (Q1, Q3)] was 32 (12, 87) months. There were 97 in the non-GC-using group, including 70 males and 27 females, aged 26 (7, 86) months. The incidence of postextubation UAO [17.4% (19/109) vs 36.1% (35/97), P=0.002] and extubation failure [2.8% (3/109) vs 11.3% (11/97), P=0.015] was lower in the GC-using group compared with the non-GC-using group. The most common GC-related adverse effect was new-onset infections (15.6%, 17/109), followed by upper gastrointestinal bleeding (6.4%, 7/109), hyperglycemia (5.5%, 6/109), and hypertension (2.8%, 3/109). Multivariable logistic regression analysis showed that systemic GC use within 24 hours before extubation was negatively associated with postextubation UAO (OR=0.386, 95%CI: 0.198-0.753) and extubation failure (OR=0.234, 95%CI: 0.063-0.871). Subgroup analysis showed that the efficacy of using systemic GC within 24 hours before extubation in reducing postextubation UAO incidence was not influenced by sex, age, intubation reason or intubation duration (all Pinteraction>0.05).

Conclusion: Systemic GC may be effective in preventing postextubation UAO in children.