Preextubation Steroids to Prevent Postextubation Laryngeal Edema

Can postextubation laryngeal edema be prevented with preextubation steroids? Limited studies have suggested that steroids might be effective when started 6 to 24 hours before extubation, but not when started less than 6 hours before. French researchers randomized 761 adults who had been on ventilators for more than 36 hours in an intensive-care setting to receive either 20 mg of intravenous methylprednisolone or matching placebo every 4 hours for 12 hours (total of 4 doses) before a planned extubation.

Patients who received methylprednisolone had significantly fewer episodes of laryngeal edema than those who received placebo (3% vs. 22%) and were significantly less likely to require reintubation for any reason (4% vs. 8%). Only one patient w…