Corticosteroids Before Extubation in Pediatric Intensive Care Unit

Inclusion criteria

• Patients intubated with an endotracheal tube with or without a cuff,
• Aged from 2 days post-term to 6 years,
• On mechanical ventilation for at least 36 hours,

And meeting the following extubation criteria:

• Extubation planned by the medical team
• Fraction of inspired oxygen (FiO2) ≤ 45%,
• Oxygen saturation measured by pulse oximeter ≥ 95% or appropriate according to the pathology,
• Positive end-expiratory pressure (PEEP) ≤ 8 cmH2O,
• Peak inspiratory pressure ≤ 22 cmH2O or presence of cough.
• Affiliated with a social security system,
• Collection of informed consent from the parental authority, by both parents or the legal guardian(s).

Exclusion criteria

• Refusal of consent by at least one parent or by the legal guardian(s),
• Patient with a contraindication to IV-DXM:

• Uncontrolled local or general infection,
• Active viral infections (hepatitis, herpes, chickenpox, shingles),
• Live vaccines,
• Severe coagulation disorders,
• Ongoing gastrointestinal bleeding,
• Known hypersensitivity to IV-DXM or one of its excipients.
• Patient participating in another interventional study involving human subjects or being in the exclusion period following a previous study involving human subjects, if applicable,
• Patient receiving State Medical Aid,
• Patient on long-term NIV,
• Known upper airway pathology (UAP) before intubation or at the time of extubation,
• History of UAP surgery within the month preceding inclusion,
• Any situation deemed incompatible with the child's participation in the trial at the discretion of the investigating physician,
• Decision to limit or stop therapeutic interventions.
• Premature patients aged less than 40 weeks of gestation
• Newborns aged less than 2 days after post-term birth