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Post-extubation stridor in Respiratory Syncytial Virus bronchiolitis: Is there a role for prophylactic dexamethasone?

Post-extubation stridor in Respiratory Syncytial Virus bronchiolitis: Is there a role for prophylactic dexamethasone?
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Veldhoen ES, Smulders CA, Kappen TH, Calis JC, van Woensel J, Raymakers-Janssen PA, Bont LJ, Hennus MP,


Veldhoen ES, Smulders CA, Kappen TH, Calis JC, van Woensel J, Raymakers-Janssen PA, Bont LJ, Hennus MP, (click to view)

Veldhoen ES, Smulders CA, Kappen TH, Calis JC, van Woensel J, Raymakers-Janssen PA, Bont LJ, Hennus MP,

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PloS one 2017 02 1612(2) e0172096 doi 10.1371/journal.pone.0172096
Abstract
AIM
The purpose of this study was to determine the incidence of reintubation due to upper airway obstruction in a homogeneous group of ventilated infants with Respiratory Syncytial Virus bronchiolitis. Our secondary objective was to determine whether prophylactic administration of dexamethasone prior to extubation was associated with decreased risk of reintubation.

METHODS
This retrospective observational study in two Pediatric Intensive Care Units in 2 university hospitals in The Netherlands included two hundred patients younger than 13 months admitted with respiratory insufficiency caused by Respiratory Syncytial Virus bronchiolitis, requiring invasive mechanical ventilation. A logistic regression analysis with propensity score method was used to adjust for possible confounding.

RESULTS
Reintubation due to post-extubation stridor occurred in 17 (8.5%) of 200 patients. After propensity score matching, administration of dexamethasone prior to extubation was associated with a significantly (p = 0.0011) decreased risk of reintubation due to post-extubation stridor compared to patients not receiving prophylactic dexamethasone (absolute risk reduction 13%, 95% CI 5.3-21%).

CONCLUSION
Reintubation due to post-extubation stridor is an important complication of ventilation for Respiratory Syncytial Virus bronchiolitis. Dexamethasone administered prior to extubation probably reduces the risk of post-extubation stridor necessitating reintubation in these infants. The results of this study support initiation of a placebo-controlled trial to confirm the beneficial effect of prophylactic dexamethasone.

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