This article is a commentary on:
Comparative efficacies of various corticosteroids for preventing postextubation stridor and reintubation: a systematic review and network meta-analysis
Yao Sun
Huiying Zhao
Ye Ma2- 1Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
- 2Department of Anesthesiology, Peking University People's Hospital, Beijing, China
by Feng, I.-J., Lin, J.-W., Lai, C.-C., Cheng, K.-C., Chen, C.-M., Chao, C.-M., Wang, Y.-T., Chiang, S.-R., and Liao, K.-M. (2023). Front. Med. 10:1135570. doi: 10.3389/fmed.2023.1135570
Introduction
The recent article by Feng et al. has drawn attention to the management of intubation and extubation in the field of critical care anesthesia (1). The article reviews some random control trials on the effect of different types of hormones on the prevention of post-intubation extubation stridor and reintubation. Using the PICOS principle, all relevant literature was reviewed and analyzed, then summarized for each trial. A net meta-analysis was performed to evaluate the quality of the articles and a subgroup analysis was attempted, resulting in 11 RCTs being included. The results of the study showed the superiority of using cortisol.
Discussion
In our clinical work, especially in tonsil and adenoidectomies in children, we have observed that many patients present with post-extubation stridor. So this side effect caught our attention. Through a brief literature search, we learned of the earlier and more frequent use of hormones to prevent the onset of this side effect. This team's meta-analysis of the literature did a good job of summarizing the results of the research over time and effectively demonstrated that hormones are a more effective means of relief.
However, it is unfortunate that the type of disease the patient has is not well-defined in this article. Regarding hormonal prevention of post-extraction stridor, most of them are still focused on the patients in the intensive care unit, and only this study by Amoozadeh and Beigmohammadi suggests the effect of hormones before extubation in general anesthesia procedures (2). We made the following list of relevant postoperative extubation stridor after a literature search (Table 1).
TABLE 1
Table 1. The review of prophylaxis of post-extubation stridor.
In addition, we also noted that some of the differences in the induction and maintenance of anesthesia may also affect the extubation of patients, such as dexmedetomidine (11). Feng's et al. also pointed out that some of the data in the literature is missing and incomplete, and we believe that this part of the data is also often a relatively critical part of the data that affects the results, for example, the use of some sedative and antagonistic drugs (1). It is hoped that there will be a careful description of randomized controlled trials in the future, which will also help us to have a more comprehensive and accurate understanding of drug efficacy.
At the same time, we found two studies on extubation position and bloodletting acupuncture interesting, both of which showed that extubation in the lateral position may reduce the probability of postoperative dyspnea (3, 4, 8).
Author contributions
YS: Writing – original draft. HZ: Funding acquisition, Writing – review & editing. YM: Writing – original draft. YA: Funding acquisition, Supervision, Writing – review & editing.
Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The research received the grant from the Youth Science Fund Program of National Natural Science Foundation of China (NSFC) (No. 82202366).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
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References
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2. Amoozadeh L, Beigmohammadi MT. The effect of dexamethasone on the reduction of airway edema and the success of extubation in patients with head and neck surgery admitted to the intensive care unit. Tehran Univ Med J. (2022) 80:128–34. Available online at: https://www.embase.com/search/results?subaction=viewrecord&id=L2019206701&from=export
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Keywords: corticosteroids, extubation, stridor, commentary, meta-analysis
Citation: Sun Y, Zhao H, Ma Y and An Y (2023) Commentary: Comparative efficacies of various corticosteroids for preventing postextubation stridor and reintubation: a systematic review and network meta-analysis. Front. Med. 10:1289321. doi: 10.3389/fmed.2023.1289321
Received: 05 September 2023; Accepted: 01 November 2023;
Published: 17 November 2023.
Edited by:
Zhongheng Zhang, Sir Run Run Shaw Hospital, ChinaReviewed by:
Lei Zhao, Capital Medical University, ChinaCopyright © 2023 Sun, Zhao, Ma and An. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Youzhong An, 2211110449@stu.pku.edu.cn