Airway edema , post extubation stridor

[Ranjithkumar]

Hi sir,
which steroids is best for airway edema or post extubation stridor
Inj Methyl pred 1m/kg 12 hr before extubation to 12 hrs after extubation every 4hourly
Or
Inj dexamethasone 1.5 mg every 6-8 hourly 24 hours prior to extubation and post extubation
Plz reply sir ?
Plz share some articles relevant to it sir
And where do you get updated of new recent articles about icu sir?
Thanks for your wonderful job in educating many of young doctors sir.

 

[drankur]

Since the overall incidence of postextubation laryngeal edema requiring reintubation is low (less than 5 percent), we believe this approach focuses therapy on those who are most likely to benefit and avoids unnecessarily prolonging mechanical ventilation for glucocorticoid therapy.

We suggest that patients who have a reduced or absent cuff leak receive a short course of glucocorticoid therapy before extubation (four hours or more). Methylprednisolone (20 mg) administered intravenously every four hours for a total of four doses prior to extubation is an acceptable regimen. Alternatively, a single dose of 40 mg of methylprednisolone administered four hours prior to extubation may be used.

Choosing one over the other should be at the discretion of the physician and depends upon the assessed risk of postextubation stridor in a given patient.

Ref: from uptodate

 

[pankajpunj]

As a protocol we use dexamethasone 8 mg IV in all adult GA patients ( long or short surgeries ) unless contraindicated. In patients undergoing laryngeal surgery we also give Hydrocortisone 100 mg IV stat before extubation . Protocols for extubation in ICU may differ.