Lancet. 2007 Mar 31;369(9567):1083-9.

François B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, Brenet O,
Preux PM, Vignon P; Association des Réanimateurs du Centre-Ouest (ARCO).

Medical-Surgical Intensive Care Unit, Dupuytren Teaching hospital, Limoges,

BACKGROUND: The efficacy of corticosteroids in reducing the incidence of
postextubation laryngeal oedema is controversial. We aimed to test our hypothesis
that methylprednisolone started 12 h before a planned extubation could prevent
postextubation laryngeal oedema. METHODS: We did a placebo-controlled,
double-blind multicentre trial in 761 adults in intensive-care units. Patients
who were ventilated for more than 36 h and underwent a planned extubation
received intravenous 20 mg methylprednisolone (n=380) or placebo (381) 12 h
before extubation and every 4 h until tube removal. The primary endpoint was
occurrence of laryngeal oedema within 24 h of extubation. Laryngeal oedema was
clinically diagnosed and deemed serious if tracheal reintubation was needed.
Analyses were done on a per protocol and intention-to-treat basis. This trial is
registered at, number NCT00199576. FINDINGS: 63 patients could
not be assessed, mainly because of self-extubation (n=16) or cancelled extubation
(44) between randomisation and planned extubation. 698 patients were analysed
(343 in placebo group, 355 in methylprednisolone group). Methylprednisolone
significantly reduced the incidence of postextubation laryngeal oedema (11 of
355, 3%vs 76 of 343, 22%, p<0.0001), the global incidence of reintubations (13 of
355, 4%vs 26 of 343, 8%, p=0.02), and the proportion of reintubations secondary
to laryngeal oedema (one of 13, 8 %vs 14 of 26, 54%, p=0.005). One patient in
each group died after extubation, and atelectasia occurred in one patient given
methylprednisolone. INTERPRETATION: Methylprednisolone started 12 h before a
planned extubation substantially reduced the incidence of postextubation
laryngeal oedema and reintubation. Such pretreatment should be considered in
adult patients before a planned extubation that follows a tracheal intubation of
more than 36 h.