Dexamethasone Dosing for Airway Edema

Pediatric Population

The French guidelines support repeated doses of IV dexamethasone before and after tracheal extubation in neonates at risk for laryngeal edema following traumatic or repeated intubation 1, 2
A negative cuff leak test increases risk of laryngeal edema, postextubation stridor, and reintubation in children 1, 2
Epinephrine nebulization may be used for postextubation stridor in children, with effectiveness lasting 2 hours, requiring PACU or ICU monitoring 1, 2

Dexamethasone 4-8 mg/day is recommended for moderately symptomatic patients with symptomatic brain metastases with vasogenic edema 3
Dexamethasone 16 mg/day is recommended for patients with marked symptoms, mass effect, elevated intracranial pressure, or impending herniation 3

IV and oral bioavailability of dexamethasone are equivalent (1:1 conversion), with 40 mg IV being equal to 40 mg oral 4
Antifungal prophylaxis should be strongly considered in patients receiving prolonged steroids 4, 5

Prophylactic corticosteroids are NOT indicated for asymptomatic patients unless receiving potentially edema-exacerbating local therapy 3
Corticosteroid duration should be minimized and tapered (not abruptly discontinued) to prevent adrenal insufficiency 3