title: Effect of nebulized budesonide on respiratory mechanics and oxygenation in acute lung injury/acute respiratory distress syndrome: Randomized controlled study.
abstract: BACKGROUND
  We tested the hypothesis that nebulized budesonide would improve lung mechanics and oxygenation in patients with early acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS) during protective mechanical ventilation strategy without adversely affecting systemic hemodynamics.
  
  
  METHODS
  Patients with ALI/ARDS were included and assigned into two groups; budesonide group (30 cases) in whom 1 mg-2 ml budesonide suspension was nebulized through the endotracheal tube and control group (30 cases) in whom 2 ml saline (placebo) were nebulized instead of budesonide. This regimen was repeated every 12 h for three successive days alongside with constant ventilator settings in both groups. Hemodynamics, airway pressures, and PaO2/FiO2were measured throughout the study period (72 h) with either nebulized budesonide or saline. Furthermore, tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) were analyzed serologically as markers of inflammation at pre- and post-nebulization sessions.
  
  
  RESULTS
  We found a significant difference between the two groups regarding PaO2/FiO2(P= 0.023), peak (P= 0.021), and plateau (P= 0.032) airway pressures. Furthermore, TNF-α, IL-1β, and IL-6 were significantly reduced after budesonide nebulizations. No significant difference was found between the two groups regarding hemodynamic variables.
  
  
  CONCLUSIONS
  Nebulized budesonide improved oxygenation, peak, and plateau airway pressures and significantly reduced inflammatory markers (TNF-α, IL-1β and IL-6) without affecting hemodynamics.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trial Registry (ANZCTR) at the number: ACTRN12615000373572.
authors.affiliation: Department of Anesthesia and Intensive Care Unit, Faculty of Medicine, Qena University Hospital, South Valley University, Qena, Egypt.
authors.forename: Hatem Saber
authors.initials: HS
authors.lastname: Mohamed
authors.affiliation: Department of Clinical Pathology, Qena University Hospital, South Valley University, Qena, Egypt.
authors.forename: Mona Mohamed Abdel
authors.initials: MM
authors.lastname: Meguid
keywords: Acute lung injury; inflammatory markers; nebulized budesonide