According to research published in Critical Care, steroid use at least 4 hours prior to extubation reduces the risk of re-intubation and stridor in selected high-risk patients.

Researchers performed a meta-analysis to determine whether prophylactic steroid therapy prevents post-extubation stridor and re-intubation.

The meta-analysis included data from 7 prospective randomised trials involving a total of 1,846 patients, of whom, 949 had received steroids. The following results were reported:
• Overall, steroids decreased significantly the risk of re-intubation (relative risk (RR), 0.58 (95%CI, 0.41-0.81); number-needed-to-treat (NNT) = 28 (20-61)) and stridor (RR, 0.48 (0.26-0.87)-NNT= 11 (8-42)).
• The effect of steroids on re-intubation and stridor was more pronounced for selected high-risk patients, as determined by a reduced cuff leak volume (respectively RR, 0.38 (0.21-0.72)-NNT= 9 (7-19) and RR, 0.40 (0.25-0.63) -NNT= 5 (95%CI, 4-8)).
• In contrast, steroid benefit was unclear when trials did not select patients for their risk of re-intubation (RR, 0.67 (0.45-1.00) - NNT= 44 (26-infinity)) or stridor (RR, 0.56 (0.20-1.55)).

The authors concluded that “The efficacy of steroids to prevent stridor and re-intubation was only observed in a high-risk population, as identified by the cuff-leak test and when it was administered at least 4 hours prior extubation. The benefit of steroids remains unclear when patients are not selected”.