Using corticosteroids to prevent postextubation laryngeal edema

The effectiveness of corticosteroids in the prevention of postextubation laryngeal edema is controversial, but a recent study conducted in France indicates that the administration of methylprednisolone before a planned extubation does, in fact, reduce the incidence of laryngeal edema and reintubation.

François and colleagues conducted a randomized, placebo-controlled, double-blind study of 698 adults in ICUs who were ventilated for more than 36 hours and underwent a planned extubation. The patients were given intravenous methylprednisolone, 20 mg, or placebo 12 hours before extubation and every 4 hours until tube removal.

The incidence of postextubation edema was significantly lower in patients who received methylprednisolone than in those who received placebo (3% vs 22%). The global incidence of reintubations and the proportion of reintubations secondary to laryngeal edema also were significantly lower in the methylprednisolone group (Table).

The authors point out that laryngeal edema is one of the most common causes of extubation failure and recommend that pretreatment with methylprednisolone be considered in adults who have been intubated for more than 36 hours.