title: Effect of inhaled corticosteroid on pulmonary injury and inflammatory mediator production after cardiopulmonary bypass in children.
abstract: OBJECTIVE
  To determine whether inhaled steroid administration after cardiopulmonary bypass will attenuate pulmonary inflammation and improve lung compliance and oxygenation.
  
  
  METHODS
  Randomized, prospective, double-blind, placebo-controlled clinical trial.
  
  
  METHODS
  Children's Hospital of Michigan, intensive care unit.
  
  
  METHODS
  Thirty-two children <2 yrs of age with congenital heart disease requiring cardiopulmonary bypass.
  
  
  METHODS
  Participants were randomly assigned to one of two groups. Group 1 (n = 16) received an inhaled steroid, Budesonide (0.25 mg/2 mL), and group 2 (n = 16) received an inhaled placebo (2 mL of inhaled 0.9% saline). The nebulizations were given at the end of cardiopulmonary bypass, 6 hrs after cardiopulmonary bypass, and 12 hrs after cardiopulmonary bypass. Two hours after each nebulization, bronchoalveolar lavage for interleukin-6 and interleukin-8 was collected.
  
  
  RESULTS
  The concentrations of interleukin-6 and interleukin-8 in the bronchoalveolar lavage increased in both groups after cardiopulmonary bypass. Interleukin-6 peaked 2 hrs after cardiopulmonary bypass and was decreasing by 14 hrs after cardiopulmonary bypass. However, administration of corticosteroid did not affect the production of interleukin-6 when compared with the placebo group (378 +/- 728 vs. 287 +/- 583 pg/mL pre-cardiopulmonary bypass, 1662 +/- 1410 vs. 1584 +/- 1645 pg/mL at the end of cardiopulmonary bypass, 2601 +/- 3132 vs. 3677 +/- 4935 pg/mL 2 hrs after cardiopulmonary bypass, and 1792 +/- 3100 vs. 1283 +/- 1344 pg/mL 14 hrs after cardiopulmonary bypass; p > .05). Likewise, interleukin-8 in the lavage fluid was similar in both the placebo and steroid groups at all time points (570 +/- 764 vs. 990 +/- 1147 pg/mL pre-cardiopulmonary bypass, 1647 +/- 1232 vs. 1394 +/- 1079 pg/mL at the end of cardiopulmonary bypass, 1581 +/- 802 vs. 1523 +/- 852 pg/mL 2 hrs after cardiopulmonary bypass, and 1652 +/- 1069 pg/mL vs. 1808 +/- 281 pg/mL 14 hrs after cardiopulmonary bypass; p > .05). Lung compliance and oxygenation were similar in both groups.
  
  
  CONCLUSIONS
  Cardiopulmonary bypass is associated with a pulmonary inflammatory response. Inhaled corticosteroid did not affect the pulmonary inflammatory response as measured by interleukin-6 and interleukin-8 concentrations in the lung lavage after cardiopulmonary bypass. Pulmonary mechanics and oxygenation were not improved by the use of inhaled corticosteroid.
authors: Department of Pediatrics, Wayne State University, Detroit, MI, USA.
authors: Alexander R
authors: AR
authors: Santos
authors: Sabrina M
authors: SM
authors: Heidemann
authors: Henry L
authors: HL
authors: Walters
authors: Ralph E
authors: RE
authors: Delius
mesh_terms: D000280:Administration, Inhalation; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology; D019819:Budesonide / Q000008:administration & dosage / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000188:drug therapy*; D018836:Inflammation Mediators / Q000032:analysis* / Q000097:blood; D015850:Interleukin-6 / Q000032:analysis / Q000097:blood; D016209:Interleukin-8 / Q000032:analysis / Q000097:blood / Q000187:drug effects; D008168:Lung / Q000187:drug effects* / Q000276:immunology / Q000502:physiology; D008170:Lung Compliance / Q000187:drug effects; D008297:Male; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000276:immunology / Q000517:prevention & control*
chemical_list: D005938:Glucocorticoids; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D019819:Budesonide