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Evidence that is Understandable, Relevant, Extendible, Current and Appraised-EURECA

Role of Parenteral Steroids to Prevent

Extubation Failure in Ventilated Children



The following piece (in italics) is presented with kind permission from the Archimedes section of Archives of Disease in Childhood(1). This is followed by examination of the evidence along
the lines of EURECA.


Archimedes



Lukkassen MA, Markhorst DG. Arch Dis Child 2006; 91; 791-793.



Clinical scenario: John, a 4-year-old boy, has been mechanically ventilated for three days during recovery from a blunt chest trauma. According to his level of ventilator support, he
is considered to be ready to be extubated. The previous patient had to
be reintubated as a result of postextubation laryngeal edema. You
wonder whether corticosteroids may reduce this risk of extubation
failure.



Structured clinical question: In mechanically ventilated children (patient), does corticosteroid administration (intervention) reduce the chance of reintubation due to laryngeal
edema (outcome)?



Search Strategy and Outcome


Secondary sources: Cochrane Database of Systematic Reviews: 1; limited to newborn infants: 1; PubMed clinical queries: "Respiration, Artificial" [MESH] AND (hydroxycorticosteroids)
[MESH] AND systematic; 1 reference not related to the question. ("Intubation,
Intratracheal" [MeSH]) AND systematic[sb] AND (Hydroxycorticosteroids)
[MESH]; no references.


PubMed: (anti-inflammatory agents OR anti-inflammatory agents/ therapeutic use OR anti-inflammatory agents/therapy OR hydroxycortico-steroids) AND systematic[sb]) AND ("intubation,
intratracheal" [MeSH] OR "respiration, artificial" [MeSH]); 25
references, 2 relevant studies. ("reintubation" or ("failure" and "extubation"))
AND (anti-inflammatory agents or anti-inflammatory agents/therapeutic
use OR anti-inflammatory agents/therapy OR hydroxycortico-steroids);
30 references, with 4 relevant. "reintub*" AND "steroids"; 30
references, 7 relevant of which 1 systematic review, 4 studies had
been analysed in systematic reviews. http://indianpediatrics.net/june2008/june-483-486.htm

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