ObjectiveTo determine whether dexamethasone prevents postextubation airway obstruction in young children.DesignProspective, randomized, double-blind, placebo-controlled study.SettingPediatric intensive care unit of a university teaching hospital.Patients48 hrs.InterventionsPatients were randomized to receive intravenous dexamethasone (0.5 mg/kg, maximum dose 10 mg) or saline, every 6 hrs for six doses, beginning 6 to 12 hrs before elective extubation.Measurements and Main ResultsDependent variables included the presence of stridor, Croup Score, and pulsus paradoxus at 10 mins, 6, 12, and 24 hrs after extubation; need for aerosolized racemic epinephrine and reintubation. The dexamethasone and placebo groups were similar in age (median 3 months [range 1 to 57] vs. 4 months [range 1 to 59], p = .6), frequency of underlying airway anomalies (3/33 vs. 3/33, p = 1.0), and duration of mechanical ventilation (median 3.3 days [range 2.1 to 39] vs. 3.5 days [range 2.1 to 15], p = .7). The dexamethasone group had a lower frequency of stridor, Croup Score, and pulsus paradoxus measurement at 10 mins and at 6 and 12 hrs after extubation. Fewer dexamethasone-treated patients required epinephrine aerosol (4/31 vs. 22/32, p < .0001) and reintubation (0/31 vs. 7/32, p < .01). Three patients exited the study early--one patient in the dexamethasone group had occult gastrointestinal hemorrhage and one patient in each group had hypertension.ConclusionPretreatment with dexamethasone decreases the frequency of postextubation airway obstruction in children.(Crit Care Med 1996; 24:1666-1669)