Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients

Crit Care Med. 2006 May;34(5):1345-50. doi: 10.1097/01.CCM.0000214678.92134.BD.


Objective: To determine whether treatment with corticosteroids decreases the incidence of postextubation airway obstruction in an adult intensive care unit.

Design: Clinical experiment.

Setting: Adult medical and surgical intensive care unit of a teaching hospital.

Patients: One hundred twenty-eight patients who were intubated for >24 hrs with a cuff leak volume <24% of tidal volume and met weaning criteria.

Interventions: : Patients were randomized into a placebo group (control, n = 43) receiving four injections of normal saline every 6 hrs, a 4INJ group (n = 42) receiving four injections of methylprednisolone sodium succinate, or a 1INJ group (n = 42) receiving one injection of the corticosteroid followed by three injections of normal saline. Cuff volume was assessed 1 hr after each injection, and extubation was performed 1 hr after the last injection. Postextubation stridor was confirmed by examination using bronchoscopy or laryngoscopy.

Measurements and main results: The incidences of postextubation stridor were lower both in the 1INJ and the 4INJ groups than in the control group (11.6% and 7.1% vs. 30.2%, both p < .05), whereas there was no difference between the two treated groups (p = .46). The cuff leak volume increased after the second and fourth injection in the 4INJ group and after a second injection in the 1INJ group compared with the control group (both p < .05).

Conclusions: A reduced cuff leak volume is a reliable indicator to identify patients at high risk to develop stridor. Treatment with a single or multiple injections of methylprednisolone can effectively reduce the occurrence of postextubation stridor.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Airway Obstruction / diagnosis
  • Airway Obstruction / etiology
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use*
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Humans
  • Injections, Intravenous
  • Intubation, Intratracheal / adverse effects*
  • Logistic Models
  • Male
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Multivariate Analysis
  • ROC Curve
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / prevention & control*
  • Respiratory Sounds / etiology*


  • Anti-Inflammatory Agents
  • Methylprednisolone