The effect of Intravenous Dexamethasone versus Inhaled Budesonide on the Reduction of Post Extubation Stridor in ICU Patients

Stridor is considered as a serious adverse complication of intubation that may lead to respiratory distress, reintubation, and further complications. Intravenous steroids including dexamethasone are assumed as an effective therapy. However, their associated side effects pose a limit on their usage. This study was carried out to elucidate the effect of intravenous dexamethasone with inhaled budesonide on the reduction of post-extubation stridor in ICU patients. This randomized clinical trial study included 80 intubated patients with extubation during their stay in the ICU ward. Prior to the extubation, a cuff-leak test was performed for all patients, and those with either negative test results or less than expected were randomly assigned to two groups of A or B (n= 40 each). Group A received 8 mg/8 hr of intravenous dexamethasone, while group B received aerosolized budesonide (0.5 mg/6 hr). Both groups received their medications starting 24 hours prior to the extubation until 24 hours afterwards. All of the patients were examined for stridor for 24 hours following the extubation. The data were collected and analyzed by SPSS-16 software using t-test, Chi-square, Fisher, and Mann-Whitney tests. Post-extubation stridor occurred in 62.5% of the patients in the dexamethasone group vs. 52.5% of the budesonide group. However, this difference is not statistically significant (P= 0.36). Similarly, the difference between the stridor scores for the two groups was not significant either (P= 0.26). Our results show that the effect of intravenous dexamethasone vs. inhaled budsonide was similar on the restriction of post-extubation stridor. Nonetheless, using aerosolized budesonide is recommended due to its fewer associated side effects.