title: Therapeutic effect of inhaled budesonide (Pulmicort® Turbuhaler) on the inflammatory response to one-lung ventilation.
abstract: This prospective, double-blind trial was designed to evaluate the effect of inhaled budesonide on lung function and the inflammatory response to one-lung ventilation. One hundred patients scheduled for lobectomy were allocated randomly to pre-operative nebulised budesonide or saline. Bronchoalveolar lavage fluid samples were collected from either the collapsed or the ventilated lung both before one-lung ventilation and 30 min after re-expansion of the lung. The concentrations of serum and bronchoalveolar lavage fluid cytokines were determined. Budesonide treatment, compared with saline, reduced both peak (mean (SD) 3.7 (0.4) vs 2.5 (0.2) kPa) and plateau (mean (SD) 3.1 (0.2) vs 2.2 (0.1) kPa, respectively, p < 0.001 for both) ventilatory pressures. Thirty minutes after re-expansion, lung compliance increased in the budesonide group compared with saline (57.5 (4.1) vs 40.1 (3.5) ml.cmH(2) O(-1), respectively p < 0.001). Budesonide also reduced the concentrations of tumour necrosis factor-α, interleukin-1β, interleukin-6 and interleukin-8 in bronchoalveolar lavage fluid, but increased interleukin-10 30 min after re-expansion (p < 0.05 for all measures). Pre-operative nebulisation of budesonide may be effective in improving ventilatory mechanics and reducing the inflammatory response to one-lung ventilation during thoracic surgery.
authors.affiliation: Department of Intensive Care Medicine, The Third Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: N Y
authors.initials: NY
authors.lastname: Ju
authors.forename: H
authors.initials: H
authors.lastname: Gao
authors.forename: W
authors.initials: W
authors.lastname: Huang
authors.forename: F F
authors.initials: FF
authors.lastname: Niu
authors.forename: W X
authors.initials: WX
authors.lastname: Lan
authors.forename: F
authors.initials: F
authors.lastname: Li
authors.forename: W
authors.initials: W
authors.lastname: Gao
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000517:prevention & control*; D000280:Administration, Inhalation; D000328:Adult; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use*; D002245:Carbon Dioxide / Q000097:blood; D016207:Cytokines / Q000097:blood / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061810:One-Lung Ventilation / Q000009:adverse effects*; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000517:prevention & control*; D011229:Preanesthetic Medication / Q000379:methods; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D016207:Cytokines; D005938:Glucocorticoids; D002245:Carbon Dioxide; D019819:Budesonide; D010100:Oxygen