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Do steroids prevent reintubation in children with laryngotracheobronchitis?

Critical care (London, England), 2000-01, Vol.4 (5), p.314-318, Article 314 [Peer Reviewed Journal]

COPYRIGHT 2000 BioMed Central Ltd. ;Copyright © 2000 Current Science Ltd 2000 Current Science Ltd ;ISSN: 1364-8535 ;EISSN: 1466-609X ;DOI: 10.1186/cc714 ;PMID: 11056758

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Title:
Do steroids prevent reintubation in children with laryngotracheobronchitis?
Author: Rajah, J ; Riera-Fanego, J ; Keeton, J ; Ramjee, A ; Bhana, R ; Lasersohn, L ; Hon, H
Subjects: Analysis of Variance ; Anti-Inflammatory Agents - pharmacology ; Anti-Inflammatory Agents - therapeutic use ; Bacterial pneumonia ; Blood Gas Analysis ; Cause of Death ; Child ; Child, Preschool ; Children ; Critical Care - methods ; Croup ; Croup - blood ; Croup - mortality ; Croup - therapy ; Diseases ; Female ; Humans ; Infant ; Intubation, Intratracheal ; Logistic Models ; Male ; Medical research ; Medicine, Experimental ; Patient Selection ; Pneumonia ; Predictive Value of Tests ; Prevention ; Primary Research ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Steroids ; Treatment Outcome
Is Part Of: Critical care (London, England), 2000-01, Vol.4 (5), p.314-318, Article 314
Description: Classic laryngotrachoebronchitis (LTB) is an inflammatory process, with oedema and secretions that involve the entire laryngotracheobronchial tree. The severity of lower airway disease in African children with LTB has previously been documented. The aim of the present study was to determine whether steroids prevent reintubation in African children with classic LTB. The study was a retrospective analysis from January 1993 to December 1996. Eighty-two black children with LTB were mechanically ventilated in the intensive care unit (ICU). By univariate regression, the estimated B coefficients for variables such as age, pneumonia, days of intubation, arterial partial oxygen tension (PaO2) : fractional inspired oxygen (FIO2) ratio, atelectasis and antibiotic use were not statistically significant (P > 0.05) as predictors for reintubation. Using multiple regression (all independent variables in combination), none of the variables acted as predictors of reintubation (P = 0.25). Steroids were shown to have no effect alone or in association with other variables in altering reintubation rates. An increase in the days of intubation showed a tendency towards reintubation (P = 0.06) in the univariate analysis (odds ratio 1.00-1.14), but showed no statistically significant difference in multivariate analysis. Of the variables used as predictors of reintubation, none acted either as a preventive factor or as a risk factor. The present results suggest that steroids should not be recommended at any stage in treatment of intubated patients with classic LTB. Prospective studies should evaluate the major risk factors for reintubation: duration of intubation, trauma to the airway at intubation and during ICU stay, and dose and timing of steroids. They should also evaluate whether upper airway disease is present alone or in association with lower airway disease.
Publisher: England: BioMed Central Ltd
Language: English
Identifier: ISSN: 1364-8535
EISSN: 1466-609X
DOI: 10.1186/cc714
PMID: 11056758
Source: Open Access: PubMed Central
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Do steroids prevent reintubation in children with laryngotracheobronchitis?

COPYRIGHT 2000 BioMed Central Ltd. ;Copyright © 2000 Current Science Ltd 2000 Current Science Ltd ;ISSN: 1364-8535 ;EISSN: 1466-609X ;DOI: 10.1186/cc714 ;PMID: 11056758

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