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Báo cáo y học: " Corticosteroids to prevent postextubation upper airway obstruction: the evidence mount"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Corticosteroids to prevent postextubation upper airway obstruction: the evidence mounts. | Available online http ccforum.eom content 11 4 156 Commentary Corticosteroids to prevent postextubation upper airway obstruction the evidence mounts Scott K Epstein Tufts University School of Medicine Pulmonary Critical Care and Sleep Medicine Division Tufts-New England Medical Center Harrison Avenue Boston Massachusetts 02111 USA Corresponding author Scott K Epstein Scott.Epstein@tufts.edu Published 14 August 2007 This article is online at http ccforum.com content 11 4 156 2007 BioMed Central Ltd Critical Care 2007 11 156 doi 10.1186 cc5976 See related research by Lee et al. http ccforum.com content 11 4 R72 Abstract Intubation of the airway can lead to laryngotracheal injury resulting in extubation failure from upper airway obstruction UAO . A number of factors can help to identify patients who are at greatest risk for post extubation UAO. Three randomized controlled trials demonstrate that prophylactic corticosteroids decrease the risk for postextubation UAO and probably the need for re-intubation. Extubation failure the need for re-intubation is associated with increased intensive care unit and hospital mortality increased length of stay in the intensive care unit and hospital greater need for tracheostomy and for long-term acute care and increased costs. Underlying severity of illness premorbid health status and complications directly associated with re-intubation fail to explain the adverse outcomes seen with extubation failure. Clinical deterioration between the time of extubation and the re-establishment of ventilatory support may provide the best explanation. Therefore preventing extubation failure has the potential to improve outcome. The study reported by Lee and coworkers 1 is one of a series of recent investigations examining whether corticosteroids can prevent postextubation upper airway obstruction UAO which is a common cause of extubation failure. Intubation and the endotracheal tube ETT may cause laryngotracheal injury resulting in inflammation .