title: Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial.
abstract: BACKGROUND
  One lung ventilation (OLV) results in inflammatory and mechanical injury, leading to intraoperative and postoperative complications in children. No interventions have been studied in children to minimize such injury.
  
  
  OBJECTIVE
  We hypothesized that a single 2-mg·kg(-1) dose of methylprednisolone given 45-60 min prior to lung collapse would minimize injury from OLV and improve physiological stability.
  
  
  METHODS
  Twenty-eight children scheduled to undergo OLV were randomly assigned to receive 2 mg·kg(-1) methylprednisolone (MP) or normal saline (placebo group) prior to OLV. Anesthetic management was standardized, and data were collected for physiological stability (bronchospasm, respiratory resistance, and compliance). Plasma was assayed for inflammatory markers related to lung injury at timed intervals related to administration of methylprednisolone.
  
  
  RESULTS
  Three children in the placebo group experienced clinically significant intraoperative and postoperative respiratory complications. Respiratory resistance was lower (P = 0.04) in the methylprednisolone group. Pro-inflammatory cytokine IL-6 was lower (P = 0.01), and anti-inflammatory cytokine IL-10 was higher (P = 0.001) in the methylprednisolone group. Tryptase, measured before and after OLV, was lower (P = 0.03) in the methylprednisolone group while increased levels of tryptase were seen in placebo group after OLV (did not achieve significance). There were no side effects observed that could be attributed to methylprednisolone in this study.
  
  
  CONCLUSIONS
  Methylprednisolone at 2 mg·kg(-1) given as a single dose prior to OLV provides physiological stability to children undergoing OLV. In addition, methylprednisolone results in lower pro-inflammatory markers and higher anti-inflammatory markers in the children's plasma.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Theroux
authors.forename: Alicia Olivant
authors.initials: AO
authors.lastname: Fisher
authors.forename: Maria E
authors.initials: ME
authors.lastname: Rodriguez
authors.forename: Robert P
authors.initials: RP
authors.lastname: Brislin
authors.forename: Kirk W
authors.initials: KW
authors.lastname: Reichard
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.forename: Matt
authors.initials: M
authors.lastname: McCoy
authors.forename: Melinda
authors.initials: M
authors.lastname: Brown
authors.forename: Kirk W
authors.initials: KW
authors.lastname: Dabney
authors.forename: William G
authors.initials: WG
authors.lastname: Mackenzie
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Katz
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Shaffer
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000097:blood / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000097:blood / Q000627:therapeutic use*; D061810:One-Lung Ventilation; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D016207:Cytokines; D008775:Methylprednisolone
keywords: cytokines; methylprednisolone; one lung ventilation; oxidative stress; pediatrics; tryptases