Methylprednisolone reduced postextubation laryngeal edema in adults with tracheal intubation.

M e t h o d s Design: Randomized placebo-controlled trial. Allocation: Concealed.* Blinding: Blinded (clinicians and patients).* Follow-up period: Up to 24 hours after extubation. Setting: 7 intensive care units in France. Patients: 761 patients 47 to 74 years of age (mean age 66 y, 64% men) who were mechanically ventilated for > 36 hours (median duration 6 d) and were to be extubated in the intensive care unit. Exclusion criteria included pregnancy, history of postextubation upper-airway obstruction, tracheostomy, throat disease or surgery, and long-term treatment with nonsteroidal antiinflammatory drugs or corticosteroids. Intervention: Intravenous methylprednisolone hemisuccinate (methylprednisolone, Merck, Lyon, France), 20 mg at 12 hours before planned extubation, followed by 20 mg every 4 hours (total dose 80 mg) (n = 380); or placebo (intravenous isotonic saline) (n = 381). Outcomes: Laryngeal edema (defined as stridor associated with signs of respiratory distress) within 24 hours after extubation. Secondary outcomes included overall reintubation, reintubation secondary to laryngeal edema, and adverse events. Patient follow-up: 92% (intention-to-treat analysis).