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Multicenter, prospective, double-blind, randomized, phase IV clinical trial involving five pediatric intensive care units. Children between 1\u00a0month and 16\u00a0years-of-age intubated for more than 48\u00a0h were included. Patients were randomized to receive placebo or dexamethasone 0.25\u00a0mg\/kg every 6\u00a0h, 6-to-12\u00a0h prior to extubation (four doses). 48\u00a0h follow-up was carried out after extubation. Severity of UAO symptoms (Taussig score, stridor) and reintubation requirement were compared. 147 patients were randomized (10 were excluded), 70 patients received dexamethasone and 67 placebo. No global differences were found in the presence of stridor or moderate-to-severe UAO symptoms (Taussig\u2009\u2265\u20095), but Taussig\u2009\u2265\u20095 was less frequent in patients less than 2\u00a0years-of-age treated with steroids (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.014). Median Taussig score was lower in the dexamethasone group 1\u00a0h after extubation,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001. 27 patients required reintubation, 9 due to UAO: 3 (4.3%) in the dexamethasone group and 6 (8.9%) in the placebo group,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.319. In those intubated &gt;\u20095\u00a0days, reintubation due to UAO was higher in the placebo group (2.4% vs. 14.3,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.052). Nebulized epinephrine and budesonide were required more frequently in the placebo group in the first 2\u00a0h (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.041) and 1\u00a0h (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) after extubation, respectively. No relevant side effects were observed. Dexamethasone prior to extubation did not significantly reduce moderate-severe UAO symptoms, except for patients under 2-years of age. Dexamethasone could decrease Taussig score and the need of rescue therapies, as well as reintubation rates in those intubated for more than 5\u00a0days.\n                  <\/jats:p>","DOI":"10.1038\/s41598-022-08178-0","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T08:06:30Z","timestamp":1647245190000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children"],"prefix":"10.1038","volume":"12","author":[{"given":"Laura","family":"Butrague\u00f1o-Laiseca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gema","family":"Manrique Mart\u00edn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Gonz\u00e1lez Cort\u00e9s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corsino","family":"Rey Gal\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuri\u00f1e","family":"Mart\u00ednez de Compa\u00f1\u00f3n Mart\u00ednez de Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Gil Ant\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Rodr\u00edguez N\u00fa\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"M Fern\u00e1ndez-Llamazares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Manrique-Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"L\u00f3pez-Herce Cid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,14]]},"reference":[{"key":"8178_CR1","doi-asserted-by":"publisher","first-page":"2657","DOI":"10.1097\/01.CCM.0000094228.90557.85","volume":"31","author":"SC Kurachek","year":"2003","unstructured":"Kurachek, S. C. et al. Extubation failure in pediatric intensive care: A multiple-center study of risk factors and outcomes. Crit. Care Med. 31, 2657\u20132664 (2003).","journal-title":"Crit. Care Med."},{"key":"8178_CR2","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1164\/rccm.201506-1064OC","volume":"193","author":"RG Khemani","year":"2016","unstructured":"Khemani, R. G. et al. Evaluating risk factors for pediatric post-extubation upper airway obstruction using a physiology-based tool. Am. J. Respir. Crit. Care Med. 193, 198\u2013209 (2016).","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"8178_CR3","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1007\/s00134-014-3358-9","volume":"40","author":"AK Baranwal","year":"2014","unstructured":"Baranwal, A. K., Meena, J. P., Singhi, S. C. & Muralidharan, J. Dexamethasone pretreatment for 24 h versus 6 h for prevention of postextubation airway obstruction in children: A randomized double-blind trial. 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