Cochrane review meta-analysis of seven randomized controlled trials
comparing steroids to placebo in neonates, children and adults.1
age groups were examined separately, decided upon prior to start of
data collecting, as authors felt there was significant anatomical and
physiological differences between these groups that they warranted separate
in the studies explained by differences in age, severity of illness
and duration of steroid use prior to extubation.
excluded studies of patients with known tracheitis, laryngitis, laryngotracheobronchitis,
external or surgical trauma to the larynx or subglottis, and studies
which failed to clearly document reasons for re-intubating patients.
the 251 studies identified, only seven met the criteria to be included
in the analysis.
studies except one examined steroid use both before and after extubation,
while one article investigated treating with steroids in patients' with
stridor following extubation. There was a wide variation in peri-extubation
steroid protocols, some administering only one dose 30 min prior to
extubation and others using multiple doses starting 12 hours prior and
continuing for up to 36 hours.
was valid in that it had an exhaustive search for articles, the articles
chosen were of high methodologic quality and weighted on both the quality
and size of the studies. There was reproducibility in the assessments
of the studies.
limited by the small number of available studies and the small sample
size within the individual studies.