Airway Literature Summaries

Francois, et al (2007) – ARCO French DCMCRCT – Lancet 363:1083-1089

  • RCT
  • n = 763
  • 20mg methylprednisolone VS placebo @ 12 hours pre-extubation if ET >36 hours + subsequent doses @ 4 hours -> reduced laryngeal oedema rate -> reduced reintubation rate -> no effect on timing of laryngeal oedema

Jaber, S., et al (2009) “Effects of steroids on reintubation and post-extubation stridor in adults: meta-analysis of randomised controlled trials” Critical Care 13 (2):1-11

  • 7 trials (RCT’s)
  • n = 1814 -> efficacy of steroids only validated in high risk patients -> high risk patients can be determined by a low level leak test (110mL or 25%) -> should be administered at least 4 hours pre-extubation -> steroids for < 24 hours were not associated with adverse effects

References

  • François B, ARCO et al.12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial. Lancet. 2007 Mar 31;369(9567):1083-9. [PMID 17398307]
  • Jaber S, Jung B, Chanques G, Bonnet F, Marret E. Effects of steroids on reintubation and post-extubation stridor in adults: meta-analysis of randomised controlled trials. Crit Care. 2009;13(2):R49. [PMID 19344515]

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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