Tao Fan and colleagues reported a meta-analysis of prophylactic administration of parenteral steroids for preventing airway complications after extubation in adults.
They identified trials as shown in the following table:
| Study | Location | Study population | Time constraint* | Mean (SD) age (years) | Sample size (% female) | Intervention in steroid group | ||
|---|---|---|---|---|---|---|---|---|
| Steroids | Placebo | Steroids | Placebo | |||||
| Gaussorgues | (France and multicentre) | Pneumonia, haemodynamic instability, postoperative, neurological | 48 hours | 55 (26) | 53 (23) | 138 (33.3) | 138 (36.2) | 40 mg IV and 40 mg IM methylprednisolone 30 min before extubation |
| Darmon | (France and multicentre) | Haemodynamic instability, neurological, postoperative | 24 hours | 49 (18.8) intubated for <36 h; 55.4 (17.9) intubated for >36 h | 47.7 (19.4) intubated for <36 h; 59.4 (19.8) intubated for >36 h | 348 (39.7) | 352 (44.6) | 8 mg IV dexamethasone 1 h before extubation |
| Ho | (Taiwan) | Haemodynamic instability, neurological, postoperative, trauma | 24 hours | 61 (14) | 64 (18) | 39 (25.6) | 38 (21.1) | 100 mg IV hydrocortisone 1 h before extubation |
| Cheng | (Taiwan) | Medical, surgical | 48 hours | 1 injection: 63 (16); 4 injections: 67 (18) | 68 (16) | 85 (1 injection: n=43 (65.1); 4 injections: n=42 (54.8)) | 43 (65.1) | Over 24 h, 40 mg IV infusion methylprednisolone every 6 h (total 160 mg) in 4 injections group; one infusion of methylprednisolone followed by three injections of normal saline every 6 h (total 40 mg) in 1 injection group |
| Francois 2007w5 | (France and multicentre) | Medical, surgical, and trauma (time constraint 24 h*) | 24 hours | 65 (46-75) | 66 (48-74) | 380 (37.0) | 381 (35.0) | 20 mg methylprednisolone initiated 12 h before planned extubation and continued every 4 h with last injection removal (total 80 mg) |
| Lee | (Taiwan) | Pneumonia, sepsis, heart failure, acute respiratory distress syndrome, COPD (time constraint 48 h*) | 48 hours | 72.4 (14.7) | 72.7 (13.8) | 40 (85.0) | 40 (88.0) | 5 mg IV dexamethasone every 6 h, total of four doses with last injection 24 h before extubation |
| *Time constraints for investigation after extubation. | ||||||||
Question 1: Is there any evidence of clinical heterogeneity between these trials?
Check suggested answer 2.
Question 3: How could the results of these trials be combined in a meta-analysis?
To Martin Bland's M.Sc. index.
This page maintained by Martin Bland.
Last updated: 18 February, 2009.