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The patients, when they stay on oxygen for a period and desaturate when weaned off, and we can’t successfully wean them, we give them dexamethasone (Dexa) and it works. But I don’t understand the mechanism, dosing, or duration. When should I use dexamethasone in respiratory distress or pneumonia, and what dose/duration is appropriate?
Airway edema or extubation:
Oral, IM, IV: 0.5 mg/kg/dose (maximum dose: 10 mg/dose) administered 6 to 12 hours prior to extubation then every 6 hours for 6 doses (total dexamethasone dose: 3 mg/kg)
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Asthma exacerbation:
Oral, IM, IV: 0.6 mg/kg once daily as a single dose or once daily for 2 days; maximum dose: 16 mg/dose. single dose regimens as low as 0.3 mg/kg/dose and as high as 1.7 mg/kg/dose have also been reported.
Note: Duration >2 days is not recommended due to increased risk of metabolic effects
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Croup, mild to severe:
Oral, IM, IV: 0.6 mg/kg once; maximum dose: 16 mg/dose, doses up to 20 mg/dose have been reported with similar efficacy; Note: Lower doses may be used in children with mild croup (0.15 to 0.6 mg/kg once)