From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For patients with no cuff leak suggesting potential post-extubation stridor, dexamethasone (Decadron) should be administered at a dose of 1.0 mg/kg IV, which is equivalent to approximately 8-10 mg IV for an average adult, every 6-8 hours for at least 24 hours before planned extubation, as this dose has been shown to improve lung function and reduce inflammation in early phase ARDS 1. This approach is based on the most recent and highest quality study available, which demonstrated that a dose of 1.0 mg/kg of dexamethasone had a faster onset of action and more effectively reduced lung neutrophils, local oxidative damage, and levels of TNFalpha, IL-6, IL-8 compared to a lower dose of 0.5 mg/kg 1. Some key points to consider when administering dexamethasone for this purpose include:
- The medication should be started well before the planned extubation, as it takes several hours to achieve its full anti-inflammatory effect.
- A multi-dose regimen is more effective than a single high dose, although a higher initial dose of 10-20 mg IV can be given if extubation is urgent and there's no time for the full pre-treatment course.
- Alternative corticosteroids like methylprednisolone (40-80 mg IV) can also be used if dexamethasone is unavailable.
- The cuff leak test can be used to predict the absence of stridor and monitor the regression of laryngeal edema after steroid treatment 2. It's worth noting that while older studies suggested that corticosteroids may not be effective in preventing postextubation laryngeal edema, more recent studies have demonstrated that prophylactic corticosteroid therapy can reduce the incidence of postextubation laryngeal edema and the subsequent need for reintubation in mechanically ventilated patients at high risk for postextubation laryngeal edema 3.