Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients

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. Postextubration 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.