The effect of dexamethasone on reducing the frequency of endotracheal intubation and mechanical ventilation required in children with acute laryngitis and laryngeal obstruction

Background: Pediatric acute laryngitis and laryngeal obstruction can be severe enough to require tubes inserted into the airway and assist with breathing. Dexamethasone is commonly used to treat pediatric acute laryngitis and laryngeal obstruction, but the factors determining the need for intubation despite corticosteroid therapy remain unclear. Objectives: We aimed to determine the rate of intubation and mechanical ventilation required, identify risk factors for these needs and examine the outcomes in pediatric patients who still require intubation despite dexamethasone treatment. Methods: A cross-sectional study at Jiangxi Children's Hospital included 160 screened patients with 150 pediatric patients with acute laryngitis and laryngeal obstruction, conducted from January 2020 to December 2024. All patients were given conventional dexamethasone treatment either orally or via IV. Patients were stratified into two groups: those who required intubation and those who did not. Demographic variables, comorbidity factors, lab values and satisfaction with dexamethasone treatment, with additional support from nebulized epinephrine, were extracted. The variables were then determined via multiple logistic regression analysis. Results: Among the 160 screened patients, 30 (18.75%) required intubation. Independent risk factors for intubation despite dexamethasone treatment included female gender (OR = 4.07), comorbid pulmonary and systemic disorders (OR = 7.30), increased neutrophil-to-lymphocyte (N/L) ratio (OR = 1.167 per unit increase), and elevated IgM levels (OR = 1.221), all with P < 0.05. These factors were identified as significant predictors for the need for intubation despite steroid therapy. Conclusion: Despite the widespread use of dexamethasone, the intubation rate remains high in pediatric patients with acute laryngitis and laryngeal obstruction. Identifying females, comorbidities, neutrophil-to-lymphocyte ratio and high levels of IgM as risk factors can assist healthcare professionals in arriving at an early diagnosis.