A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children
Rationale: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. Objectives: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation...
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| Beste egile batzuk: | , , , , , , , , , |
| Formatua: | article |
| Hizkuntza: | ingelesa |
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2023
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| Gaiak: | |
| Sarrera elektronikoa: | https://hdl.handle.net/20.500.12008/53014 |
| Etiketak: |
Etiketarik gabe, Izan zaitez lehena erregistro honi etiketa jartzen!
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| _version_ | 1868890027325390848 |
|---|---|
| author | Iyer, Narayan P. |
| author2 | López-Fernández, Yolanda M. González-Dambrauskas, Sebastián Baranwal, Arun K. Hotz, Justine C. Meng, Zhu Yuan, Zhang Craven, Hannah J. Whipple, Elizabeth C. Abu-Sultaneh, Samer Khemani, Robinder G. |
| author2_role | author author author author author author author author author author |
| author_browse | Abu-Sultaneh, Samer Baranwal, Arun K. Craven, Hannah J. González-Dambrauskas, Sebastián Hotz, Justine C. Iyer, Narayan P. Khemani, Robinder G. López-Fernández, Yolanda M. Meng, Zhu Whipple, Elizabeth C. Yuan, Zhang |
| author_facet | Iyer, Narayan P. López-Fernández, Yolanda M. González-Dambrauskas, Sebastián Baranwal, Arun K. Hotz, Justine C. Meng, Zhu Yuan, Zhang Craven, Hannah J. Whipple, Elizabeth C. Abu-Sultaneh, Samer Khemani, Robinder G. |
| author_role | author |
| collection | COLIBRI |
| dc.contributor.none.fl_str_mv | Iyer Narayan P., University of Southern California (E.E.U.U.) López-Fernández Yolanda M., Hospital Universitario de Cruces (España) González-Dambrauskas Sebastián, Universidad de la República (Uruguay). Facultad de Medicina Baranwal Arun K., Institute of Medical Education and Research (India) Hotz Justine C., Children's Hospital Los Angeles (E.E.U.U.) Meng Zhu, McMaster University (Canadá) Yuan Zhang, McMaster University (Canadá) Craven Hannah J., Indiana University School of Medicine (E.E.U.U.) Whipple Elizabeth C., Indiana University School of Medicine (E.E.U.U.) Abu-Sultaneh Samer, Indiana University School of Medicine (E.E.U.U.) Khemani Robinder G., University of Southern California (E.E.U.U.) |
| dc.creator.none.fl_str_mv | Iyer, Narayan P. López-Fernández, Yolanda M. González-Dambrauskas, Sebastián Baranwal, Arun K. Hotz, Justine C. Meng, Zhu Yuan, Zhang Craven, Hannah J. Whipple, Elizabeth C. Abu-Sultaneh, Samer Khemani, Robinder G. |
| dc.date.none.fl_str_mv | 2023 2025-12-17T15:34:51Z 2025-12-17T15:34:51Z |
| dc.format.none.fl_str_mv | 13 p. application/pdf |
| dc.identifier.none.fl_str_mv | Iyer N, López-Fernández Y, González-Dambrauskas S y otros. A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children. Annals of the American Thoracic Society [en línea]. 2023;20(1):118-130 2325-6621 https://hdl.handle.net/20.500.12008/53014 10.1513/AnnalsATS.202203-212OC |
| dc.language.none.fl_str_mv | en eng |
| dc.publisher.none.fl_str_mv | American Thoracic Society |
| dc.relation.none.fl_str_mv | Annals of the American Thoracic Society. 2023;20(1):118-130 |
| dc.rights.none.fl_str_mv | info:eu-repo/semantics/openAccess Licencia Creative Commons Atribución - No Comercial - Sin Derivadas (CC - By-NC-ND 4.0) |
| dc.source.none.fl_str_mv | reponame:COLIBRI instname:Universidad de la República instacron:Universidad de la República |
| dc.subject.none.fl_str_mv | Dexamethasone Upper airway obstruction Extubation Meta-analysis CORTICOESTEROIDES EXTUBACIÓN TRAQUEAL OBSTRUCCIÓN DE LAS VÍAS AÉREAS TEOREMA DE BAYES NIÑO TRASTORNOS RESPIRATORIOS |
| dc.title.none.fl_str_mv | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
| dc.type.none.fl_str_mv | Artículo info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| description | Rationale: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. Objectives: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. Methods: MEDLINE, CINAHL, and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 h before extubation) and the dose (high dose: ⩾0.5 mg/kg/dose). We performed Bayesian network meta-analysis with studies grouped into four regimens: high dose, early use (HE); low dose, early use (LE); high dose, late use (HL); and low dose, late use. Results: Eight trials (n = 903) were included in the analysis. For preventing UAO (odds ratio; 95% credible interval), HE (0.13; 0.04-0.36), HL (0.39; 0.19-0.74), and LE (0.15; 0.04-0.58) regimens appear to be more effective than no dexamethasone (low certainty). HE and LE had the highest probability of being the top-ranked regimens for preventing UAO (surface under the cumulative ranking curve 0.901 and 0.808, respectively). For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared with no dexamethasone (very low certainty). HE and LE were the top-ranked regimens (surface under the cumulative ranking curve 0.803 and 0.720, respectively) for preventing reintubation. Sensitivity analysis showed that regimens that started >12 hours before extubation were likely more effective than regimens started >6 hours before extubation. Conclusions: Periextubation dexamethasone can prevent postextubation UAO in children, but effectiveness is highly dependent on timing and dosing regimen. Early initiation (ideally >12 h before extubation) appears to be more important than the dose of dexamethasone. Ultimately, the specific steroid strategy should be personalized, considering the potential for adverse events associated with dexamethasone and the individual risk of UAO and reintubation. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | anni_473e1046bb5faa76d2b07775544def2a |
| identifier_str_mv | Iyer N, López-Fernández Y, González-Dambrauskas S y otros. A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children. Annals of the American Thoracic Society [en línea]. 2023;20(1):118-130 2325-6621 10.1513/AnnalsATS.202203-212OC |
| instacron_str | Universidad de la República |
| institution | Universidad de la República |
| instname_str | Universidad de la República |
| language | eng |
| language_invalid_str_mv | en |
| network_acronym_str | anni |
| network_name_str | oai-lr-anni |
| oai_identifier_str | oai:colibri.udelar.edu.uy:20.500.12008/53014 |
| publishDate | 2023 |
| publishDateSort | 2023 |
| publisher.none.fl_str_mv | American Thoracic Society |
| reponame_str | COLIBRI |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | Licencia Creative Commons Atribución - No Comercial - Sin Derivadas (CC - By-NC-ND 4.0) |
| spelling | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in ChildrenIyer, Narayan P.López-Fernández, Yolanda M.González-Dambrauskas, SebastiánBaranwal, Arun K.Hotz, Justine C.Meng, ZhuYuan, ZhangCraven, Hannah J.Whipple, Elizabeth C.Abu-Sultaneh, SamerKhemani, Robinder G.DexamethasoneUpper airway obstructionExtubationMeta-analysisCORTICOESTEROIDESEXTUBACIÓN TRAQUEALOBSTRUCCIÓN DE LAS VÍAS AÉREASTEOREMA DE BAYESNIÑOTRASTORNOS RESPIRATORIOSRationale: Periextubation corticosteroids are commonly used in children to prevent upper airway obstruction (UAO). However, the best timing and dose combination of corticosteroids is unknown. Objectives: To compare effectiveness of different corticosteroid regimens in preventing UAO and reintubation. Methods: MEDLINE, CINAHL, and Embase search identified randomized trials in children using corticosteroids to prevent UAO. All studies used dexamethasone. The studies were categorized based on timing of initiation of dexamethasone (early use: >12 h before extubation) and the dose (high dose: ⩾0.5 mg/kg/dose). We performed Bayesian network meta-analysis with studies grouped into four regimens: high dose, early use (HE); low dose, early use (LE); high dose, late use (HL); and low dose, late use. Results: Eight trials (n = 903) were included in the analysis. For preventing UAO (odds ratio; 95% credible interval), HE (0.13; 0.04-0.36), HL (0.39; 0.19-0.74), and LE (0.15; 0.04-0.58) regimens appear to be more effective than no dexamethasone (low certainty). HE and LE had the highest probability of being the top-ranked regimens for preventing UAO (surface under the cumulative ranking curve 0.901 and 0.808, respectively). For preventing reintubation, the effect estimate was imprecise for all four dexamethasone regimens compared with no dexamethasone (very low certainty). HE and LE were the top-ranked regimens (surface under the cumulative ranking curve 0.803 and 0.720, respectively) for preventing reintubation. Sensitivity analysis showed that regimens that started >12 hours before extubation were likely more effective than regimens started >6 hours before extubation. Conclusions: Periextubation dexamethasone can prevent postextubation UAO in children, but effectiveness is highly dependent on timing and dosing regimen. Early initiation (ideally >12 h before extubation) appears to be more important than the dose of dexamethasone. Ultimately, the specific steroid strategy should be personalized, considering the potential for adverse events associated with dexamethasone and the individual risk of UAO and reintubation.American Thoracic SocietyIyer Narayan P., University of Southern California (E.E.U.U.)López-Fernández Yolanda M., Hospital Universitario de Cruces (España)González-Dambrauskas Sebastián, Universidad de la República (Uruguay). Facultad de MedicinaBaranwal Arun K., Institute of Medical Education and Research (India)Hotz Justine C., Children's Hospital Los Angeles (E.E.U.U.)Meng Zhu, McMaster University (Canadá)Yuan Zhang, McMaster University (Canadá)Craven Hannah J., Indiana University School of Medicine (E.E.U.U.)Whipple Elizabeth C., Indiana University School of Medicine (E.E.U.U.)Abu-Sultaneh Samer, Indiana University School of Medicine (E.E.U.U.)Khemani Robinder G., University of Southern California (E.E.U.U.)2025-12-17T15:34:51Z2025-12-17T15:34:51Z2023Artículoinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion13 p.application/pdfIyer N, López-Fernández Y, González-Dambrauskas S y otros. A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children. Annals of the American Thoracic Society [en línea]. 2023;20(1):118-1302325-6621https://hdl.handle.net/20.500.12008/5301410.1513/AnnalsATS.202203-212OCreponame:COLIBRIinstname:Universidad de la Repúblicainstacron:Universidad de la RepúblicaenengAnnals of the American Thoracic Society. 2023;20(1):118-130Las obras depositadas en el Repositorio se rigen por la Ordenanza de los Derechos de la Propiedad Intelectual de la Universidad de la República.(Res. Nº 91 de C.D.C. de 8/III/1994 – D.O. 7/IV/1994) y por la Ordenanza del Repositorio Abierto de la Universidad de la República (Res. Nº 16 de C.D.C. de 07/10/2014)info:eu-repo/semantics/openAccessLicencia Creative Commons Atribución - No Comercial - Sin Derivadas (CC - By-NC-ND 4.0)oai:colibri.udelar.edu.uy:20.500.12008/530142026-04-14T10:28:23Z |
| spellingShingle | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children Iyer, Narayan P. Dexamethasone Upper airway obstruction Extubation Meta-analysis CORTICOESTEROIDES EXTUBACIÓN TRAQUEAL OBSTRUCCIÓN DE LAS VÍAS AÉREAS TEOREMA DE BAYES NIÑO TRASTORNOS RESPIRATORIOS |
| status_str | publishedVersion |
| title | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
| title_full | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
| title_fullStr | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
| title_full_unstemmed | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
| title_short | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
| title_sort | A Network Meta-analysis of Dexamethasone for Preventing Postextubation Upper Airway Obstruction in Children |
| topic | Dexamethasone Upper airway obstruction Extubation Meta-analysis CORTICOESTEROIDES EXTUBACIÓN TRAQUEAL OBSTRUCCIÓN DE LAS VÍAS AÉREAS TEOREMA DE BAYES NIÑO TRASTORNOS RESPIRATORIOS |
| url | https://hdl.handle.net/20.500.12008/53014 |