Exercise: Prophylactic administration of parenteral steroids

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:

Characteristics of included randomised placebo controlled trials on parenteral steroids for preventing complications after extubation in adults

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 1.

Two complications of extubation were reported as adverse outcomes: the presence or absence of laryngeal oedema and whether there was the need for re-intubation.

Question 2: What kind of variable are the outcomes in these trials?

Check suggested answer 2.

Question 3: How could the results of these trials be combined in a meta-analysis?

Check suggested answer 3.

Figure 1 shows the comparison of steroids with placebo for prevention of laryngeal oedema:

Figure 1. Comparison of steroids with placebo for prevention of laryngeal oedema

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Question 4: What kind of horizontal scale is used in Figure 1 and why?

Check suggested answer 4.

Question 5: In Figure 1, is there evidence of statistical heterogeneity?

Check suggested answer 5.

Question 6: What conclusions could we draw about the effect of steroids on laryngeal oedema?

Check suggested answer 6.

Figure 2 shows the comparison of steroids with placebo for prevention of re-intubation:

Figure 2. Comparison of steroids with placebo for prevention of re-intubation

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Question 7: In Figure 2, why are there arrowheads on the lines for Francois and for Gaussorgues?

Check suggested answer 7.

Question 8: Is there evidence of statistical heterogeneity in Figure 2?

Check suggested answer 8.

Question 9: What conclusions could we draw about the effect of steroids on re-intubation?

Check suggested answer 9.

Reference

To Systematic Reviews index.

To Martin Bland's M.Sc. index.

To Martin Bland's home page.

This page maintained by Martin Bland.
Last updated: 18 February, 2009.

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