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Laryngeal edema is the most frequent complication following prolonged endotracheal intubation. Investigators conducted a multicenter, industry-sponsored, placebo-controlled, double-blind study in 761 adults who had been intubated for longer than 36 hours. Patients received either methylprednisolone (20 mg) or placebo 12 hours before planned extubation and every 4 hours until the extubation.
Intravenous methylprednisolone, compared with placebo, significantly reduced the incidence of postextubation laryngeal edema within 24 hours of extubation (3% vs. 22%) and the need for reintubation (4% vs. 8%). Factors associated with postextubation edema included female sex, shorter height, a diagnosis of trauma, and orotracheal intubation with larger tu…