Preventing Laryngeal Edema Using Single Dose Methylprednisolone in Critically Ill Patients

Background: Post extubation stridor (PES) is a common concern in mechanically ventilated patients, and various therapies have been explored to prevent its occurrence. This study aimed to compare the effectiveness of a single dose of corticosteroid with a placebo in patients at high risk for PES, as determined by cuff leak volume and laryngeal air column width difference (LACWD). Methodology: A randomized clinical trial was conducted in a tertiary care hospital, involving 222 patients aged >18 years of both genders who had been on mechanical ventilation for more than 24 hours and were planned for extubation. Group A (intervention) received methylprednisolone sodium succinate at a dose of 40 mg in 2 ml normal saline, while Group B (placebo) received 2 ml normal saline. Patients were divided into two groups based on cuff leak percentage and LACWD: a low-risk group (Group 1) with cuff leak > 24% and/or LACWD > 0.9 mm, and a high-risk group (Group 2) with cuff leak < 24% and/or LACWD < 0.9 mm. Results: Post extubation stridor occurred in 2 (2.7%) patients in Group 1 (low-risk group) and in 34 (23.0%) patients in Group 2 (high-risk group) (p=0.00). In Group 2, PES was observed in 9 (12.2%) patients who received methylprednisolone (Group A) and in 25 (33.8%) patients who received the placebo (Group B) (p=0.00). Reintubation was required in 1 (1.4%) patient in Group 1 and in 18 (12.2%) patients in Group 2 (p=0.00). Among Group 2 patients, reintubation was needed in 5 (5.24%) patients in Group A and 14 (18.9%) patients in Group B (p=0.01). Patients who developed PES had significantly lower mean cuff leak and mean LACWD compared to those who did not develop PES (19.6% vs 22.6%; p=0.00 and 0.79 mm vs 0.85 mm; p=0.004, respectively). Notably, PES was observed more frequently in females. Conclusions: Treatment with methylprednisolone significantly reduced the incidence of PES and the need for reintubation in high-risk patients compared to the placebo group. Patients who developed PES had lower cuff leak and LACWD values, and a higher proportion of females experienced PES.