Croup: the steroid saga

13 January, 2011 by: colinparker

Post to Twitter

Dex or Pred? What dose? Grandmaster G helps us navigate the steroid evolution of the last couple of decades. We’re almost there, just one big RCT until we know the answer!

To listen to this podcast, click on the media below, or subscribe using iTunes or another podcatcher. Feel free to share with your colleagues!


Steroids for Croup

Introduction & disclaimer
History – steroids introduction

[GG] initial disbelief in steroids for croup

[SF] Pred for intubated patients – Tibballs Lancet 1992

[CP] Geelhoed 1995 dex vs budesonide vs placebo

[CP] Geelhoed GC, Macdonald WB. 1995 0.6 vs 0.3 vs 0.15 (dose-finding)

[CP] Geelhoed 1996 (BMJ) dex 0.15 vs placebo for mild croup (outpatient)

[KB] Geelhoed 1996 (Annals Emerg Med): Sixteen years’ experience

[CP] Latest Cochrane review: Russell 2004 (Jan)
31 studies included, N=3736
Steroids work within 6 hrs and decrease admission, length of stay, return visits
Implications for research: optimal dose dex needs to be defined (0.15 vs 0.6); dissemination of evidence / physician uptake

[CP] PECARN Bjornson 2004 (Sept)
dex 0.6mg/kg vs placebo! N=720
Representation rate halved from 15 to 7 percent, less stress for parents

Pred vs Dex papers

[SF] Sparrow  2005 (n=133)

[KB] Alison Fifoot & Joseph Ting EMA 2007 (n=99)

[SF] 2009 Milana & Gary 27 yrs’ experience: progress paper

[CP] Dose of dex finally settled?
bestBET Port 2009
but Review in NEJM 2008 by James Cherry still recommends dex 0.6

[CP] Introduction to ToPDoG study
Aiming to recruit 3 x 437 subjects
Details on ANZCTR website

New directions

[KB] ?heliox

[SF] Coronavirus – a newly identified pathogen

[CP] ?paraflu vaccine

[all] Summary / pearls

[CP] Thanks to Gary

[all] Goodbye & Begood

Post to Twitter

Share

Comments

One Response to “Croup: the steroid saga”

Leave a Reply