Effect of inhaled corticosteroid on pulmonary injury and inflammatory mediator production after cardiopulmonary bypass in children.
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.
Santos
Alexander R
AR
Department of Pediatrics, Wayne State University, Detroit, MI, USA.
Heidemann
Sabrina M
SM
Walters
Henry L
HL
Delius
Ralph E
RE
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*
D005938:Glucocorticoids; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D019819:Budesonide