{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T01:27:24Z","timestamp":1778808444011,"version":"3.51.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T00:00:00Z","timestamp":1690156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>We assessed the efficacies of various corticosteroid treatments for preventing postexubation stridor and reintubation in mechanically ventilated adults with planned extubation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the Pubmed, Embase, the Cochrane databases and <jats:ext-link>ClinicalTrial.gov<\/jats:ext-link> registration for articles published through September 29, 2022. Only randomized controlled trials (RCTs) that compared the clinical efficacies of systemic corticosteroids and other therapeutics for preventing postextubation stridor and reintubation were included. The primary outcome was postextubation stridor and the secondary outcome was reintubation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 11 assessed RCTs reported 4 nodes: methylprednisolone, dexamethasone, hydrocortisone, and placebo, which yielded 3 possible pairs for comparing the risks of post extubation stridor and 3 possible pairs for comparing the risks of reintubation. The risk of postextubation stridor was significantly lower in dexamethasone- and methylprednisolone-treated patients than in placebo-treated patients (dexamethasone: OR = 0.39; 95% CI = 0.22\u20130.70; methylprednisolone: OR = 0.22; 95% CI = 0.11\u20130.41). The risk of postextubation stridor was significantly lower in methylprednisolone-treated patients than in hydrocortisone-treated: OR = 0.24; 95% CI = 0.08\u20130.67) and dexamethasone-treated patients: OR = 0.55; 95% CI = 0.24\u20131.26). The risk of reintubation was significantly lower in dexamethasone- and methylprednisolone-treated patients than in placebo-treated patients: (dexamethasone: OR = 0.34; 95% CI = 0.13\u20130.85; methylprednisolone: OR = 0.42; 95% CI = 0.25\u20130.70). Cluster analysis showed that dexamethasone- and methylprednisolone-treated patients had the lowest risks of stridor and reintubation. Subgroup analyses of patients with positive cuff-leak tests showed similar results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Methylprednisolone and dexamethasone were the most effective agents against postextubation stridor and reintubation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1135570","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T14:15:41Z","timestamp":1690208141000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Comparative efficacies of various corticosteroids for preventing postextubation stridor and reintubation: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"10","author":[{"given":"I-Jung","family":"Feng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia-Wei","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Cheng","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuo-Chen","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chin-Ming","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Ming","family":"Chao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Ting","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyh-Ren","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuang-Ming","family":"Liao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1111\/j.1460-9592.2010.03360.x","article-title":"Barotrauma: a life-threatening complication of fiberoptic endotracheal intubation in a neonate","volume":"20","author":"Khan","year":"2010","journal-title":"Paediatr Anaesth."},{"key":"B2","doi-asserted-by":"publisher","first-page":"S159","DOI":"10.1002\/lary.21623","article-title":"Tongue necrosis: a rare complication of oral intubation","volume":"120","author":"Kuhn","year":"2010","journal-title":"Laryngoscope."},{"key":"B3","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/0003489416678008","article-title":"Soft palate injuries during orotracheal intubation with the videolaryngoscope","volume":"126","author":"Pham","year":"2017","journal-title":"Ann Otol Rhinol Laryngol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1097\/00024720-200204000-00007","article-title":"Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema following intubation with a double-lumen endotracheal tube for thoracoscopic anterior spinal release and fusion in a patient with idiopathic scoliosis","volume":"15","author":"Sucato","year":"2002","journal-title":"J Spinal Disord Tech."},{"key":"B5","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/iwj.12291","article-title":"Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review","volume":"13","author":"Xu","year":"2016","journal-title":"Int Wound J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1186\/cc8142","article-title":"Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients","volume":"13","author":"Wittekamp","year":"2009","journal-title":"Crit Care."},{"key":"B7","doi-asserted-by":"publisher","first-page":"a1841","DOI":"10.1136\/bmj.a1841","article-title":"Prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults: meta-analysis of randomised placebo controlled trials","volume":"337","author":"Fan","year":"2008","journal-title":"BMJ."},{"key":"B8","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1007\/s00134-009-1473-9","article-title":"Corticosteroids to prevent extubation failure: a systematic review and meta-analysis","volume":"35","author":"McCaffrey","year":"2009","journal-title":"Intensive Care Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/j.chest.2017.02.017","article-title":"Prophylactic corticosteroids for prevention of postextubation stridor and reintubation in adults: a systematic review and meta-analysis","volume":"151","author":"Kuriyama","year":"2017","journal-title":"Chest."},{"key":"B10","unstructured":"Role of dexamethasone for prevention of post-extubation airway obstruction in critically ill adult patients38\n            BalochR\n            JakhraniN\n            LalAS\n            MehmoodNA\n          J Surg Pak [International]152010"},{"key":"B11","first-page":"503","article-title":"Methylprednisolone reduces the rates of postextubation stridor and reintubation associated with attenuated cytokine responses in critically ill patients","volume":"77","author":"Cheng","year":"2011","journal-title":"Minerva Anestesiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1097\/01.CCM.0000214678.92134.BD","article-title":"Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients","volume":"34","author":"Cheng","year":"2006","journal-title":"Crit Care Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1097\/00000542-199208000-00004","article-title":"Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone: a placebo-controlled, double-blind, multicenter study","volume":"77","author":"Darmon","year":"1992","journal-title":"Anesthesiology."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/S0140-6736(07)60526-1","article-title":"12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial","volume":"369","author":"Fran\u00e7ois","year":"2007","journal-title":"Lancet."},{"key":"B15","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1097\/00003246-198806000-00021","article-title":"Do corticosteroids prevent postextubation laryngeal edema? prospective study of 276 adults","volume":"16","author":"Gaussorgues","year":"1988","journal-title":"Crit Care Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1007\/BF02044118","article-title":"Postextubation laryngeal edema in adults. risk factor evaluation and prevention by hydrocortisone","volume":"22","author":"Ho","year":"1996","journal-title":"Intensive Care Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"R72","DOI":"10.1186\/cc5957","article-title":"Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study","volume":"11","author":"Lee","year":"2007","journal-title":"Crit Care."},{"key":"B18","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.ijge.2015.10.002","article-title":"Comparison of high-and low-dose dexamethasone for preventing postextubation airway obstruction in adults: a prospective, randomized, double blind, placebo-controlled study","volume":"10","author":"Lee","year":"2016","journal-title":"Int J Gerontol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"A593","DOI":"10.1097\/01.CCM.0000262548.97035.1C","article-title":"Methylprednisolone reduces the incidence of postextubation stridor associated with downregulation of IL-6 in critical ill patients","volume":"7","author":"Cheng","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The prisma 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ."},{"key":"B21","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v106.i02","article-title":"netmeta: an R package for network meta-analysis using frequentist methods","volume":"106","author":"Balduzzi","year":"2023","journal-title":"J Stat Softw."},{"key":"B24","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1023\/A:1021394316112","article-title":"A decision criterion for the optimal number of clusters in hierarchical clustering","volume":"25","author":"Jung","year":"2003","journal-title":"J Global Optimization."},{"key":"B25","first-page":"442","article-title":"Randomized comparative efficacy of dexamethasone to prevent postextubation upper airway complications in children and adults in ICU","volume":"53","author":"Malhotra","year":"2009","journal-title":"Indian J Anaesth"},{"key":"B26","first-page":"A593","article-title":"Multiple injections of hydrocortisone for the prevention of post-extubation stridor in acute respiratory failure","author":"Shih","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"B27","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ijge.2015.10.002","article-title":"Comparison of high-and low-dose dexamethasone for preventing postextubation airway obstruction in adults: a prospective, randomized, double blind, placebo-controlled study","volume":"10","author":"Lin","year":"2016","journal-title":"Int J Gerontol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1136\/ard.61.8.718","article-title":"Standardized nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology","volume":"61","author":"Buttgereit","year":"2002","journal-title":"Ann Rheum Dis."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1135570\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T14:15:47Z","timestamp":1690208147000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1135570\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,24]]},"references-count":28,"alternative-id":["10.3389\/fmed.2023.1135570"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1135570","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,24]]},"article-number":"1135570"}}