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Online ISSN 1827-1596
Cheng K. C. 1-3, Chen C. M. 1,4,5, Tan C. K.1,4,5, Chen H. M. 1, Lu C. L. 6, Zhang H. 7,8
1 Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan;
2 Department of Internal Medicine, National Defense Medical Center, Taipei, Taiwan;
3 Department of Safety Health and Environment, Chung Hwa University of Medical Technology, Tainan, Taiwan;
4 Department of Respiratory Therapy, Chang Jung University, Tainan, Taiwan;
5 Department of Medicine, Taipei Medical University;
6 Department of Medical Research, Chi Mei Medical Center;
7 The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada; 8Departments of Anesthesia, Critical Care Medicine and Physiology, University of Toronto, Toronto, ON, Canada
BACKGROUND: Treatment with corticosteroids can reduce the incidence of postextubation stridor (PES) and reintubation in critically ill adult patients, but the mechanisms remain unknown.
METHODS: A randomized, controlled clinical trial was conducted in an adult medical and surgical Intensive Care Unit (ICU) of a teaching hospital. Seventy-one patients who had a cuff leak percentage <24% of tidal volume received either a bolus injection of methylprednisolone at 40 mg (treated group, n=38) or normal saline (placebo group, n=33) 4 h prior to a planned extubation. The cuff leak percentage was re-assessed 1 h and 4 h post-injection. Eighty patients who had a cuff leak percentage ≥24% served as a control group. Plasma concentrations of multiple cytokines and C-reactive protein (CRP) were measured at baseline, 4 h and 24 h after the intervention.
RESULTS: The incidences of PES (15.8% vs. 39.4%, P<0.05) and reintubation rate (7.9% vs. 30.3%, P<0.05) were lower in the treated group compared to the placebo group. The plasma concentrations of IL-4 and IL-10 increased while the levels of IL-6 and IL-8 decreased at 24 h in the treated group compared to the placebo group. No difference in CRP levels was observed between the treated and placebo groups.
CONCLUSION: A single injection of methylprednisolone at the dose used 4 h prior to planned extubation effectively reduced the incidence of PES and the reintubation rate. These beneficial effects were associated with the up-regulation of IL-4 and IL-10 and the down-regulation of IL-6 and IL-8 in the critically ill adult patients.