The question to be evaluated today is what is the role of steroids in preventing post-extivation strider and reducing the risk of reinvation.

The first study we're going to look at is from chess.

The principal author is Marine Mead and the title of the paper is trials of critical steroids

to prevent post-extubation airway complications.

It's from Chess 2001, Volume 120, pages 464 to 468 in supplement.

The original edema and the result in strider are common problems in children following

tracheal extubation after mechanical ventilation.

Not infrequently airway compromise necessitates in a tracheal re-inibation.

The sequence of events also occurs in adults, although far less often.

Pre-extubation corticosteroid administration might, in theory, ameliorate this problem.

The anti-inflammatory effects of cortical steroids could prevent or attenuate the degree of laryngeal edema. In cases that might otherwise be mild, corticosteroids might even eliminate significant

edema. However, it is plausible that corticosteroid therapy might have insufficient time to act to prevent laryngeal edema,

or might, for a variety of other reasons, have a minimal

therapeutic impact.

Randomized control trials represent the only way to definitely resolve this issue, focusing

on outcomes of importance to patients.

In this trial, the authors review the trials that investigators have conducted in both pediatric

and adult patients.

The authors present their methodology as well as their statistical results, and those will be

included in the paper presented on the website.

But going to the discussion, two well-designed trials of Dexomethazone therapy prior to

extubation and children have unequivocally demonstrated that steroids reduce post-extubation strider.

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