Low dose methylprednisolone prophylaxis to reduce inflammation during one‐lung ventilation

Theroux, Mary C.; Olivant, Alicia; Lim, Doyle; Bernardi, John P.; Costarino, Andrew T.; Shaffer, Thomas H.; Miller, Thomas L.

doi:10.1111/j.1460-9592.2008.02667.x

Cited by 13 publications

(10 citation statements)

References 29 publications

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Section: Introductionmentioning

confidence: 99%

“…The intervention proposed here, a single dose (2 mg·kg −1 ) of methylprednisolone (MP) given prior to OLV, was studied in our piglet model of OLV . It demonstrated reduced inflammatory markers both in plasma and the lung tissue and was shown to further decrease neutrophil infiltrates in the alveoli . Our primary hypothesis for this clinical study was that MP given in a single dose of 2‐mg·kg −1 prior to OLV would result in improved physiological stability by decreasing the incidence of bronchospasm and thus decreasing the failure of OLV in children.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial

Theroux

Fisher²,

Rodríguez

et al. 2015

Pediatric Anesthesia

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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 dose of methylprednisolone given 45–60 minutes prior to lung collapse will minimize injury from OLV and improve physiological stability. Methods Twenty-eight children scheduled to undergo OLV were randomly assigned to receive 2 mg/kg 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 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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial

Theroux

Fisher²,

Rodríguez

et al. 2015

Pediatric Anesthesia

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show abstract

“…We have previously reported on the lung injury associated with OLV in an animal model and found the use of both protective ventilation 10 and the anti-inflammatory drug methylprednisolone 11 to reduce the levels of pro-inflammatory cytokines. In this study, we focus on characterizing inflammatory and oxidative injury to the lungs during OLV, and we hypothesize that a lower FiO 2 during OLV will result in less inflammatory and oxidative injury in the lung and in improved lung mechanics.…”

Section: Introductionmentioning

confidence: 99%

Hyperoxia during one lung ventilation: Inflammatory and oxidative responses

Fisher

Husain

Wolfson

et al. 2012

Pediatric Pulmonology

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Summary Background It is common practice during one lung ventilation (OLV) to use 100% oxygen, although this may cause hyperoxia- and oxidative stress-related lung injury. We hypothesized that lower oxygen (FiO2) during OLV will result in less inflammatory and oxidative lung injury and improved lung function. Methods Twenty pigs (8.88 ± 0.84 kg; 38 ± 4.6 days) were assigned to either the hyperoxia group (n = 10; FiO2 = 100%) or the normoxia group (n = 10; FiO2 < 50%). Both groups were subjected to 3 hr of OLV. Blood samples were tested for pro-inflammatory cytokines and lung tissue was tested for these cytokines and oxidative biomarkers. Results There were no differences between groups for partial pressure of CO2, tidal volume, end-tidal CO2, plasma cytokines, or respiratory compliance. Total respiratory resistance was greater in the hyperoxia group (P = 0.02). There were higher levels of TNF-α, IL-1β, and IL-6 in the lung homogenates of the hyperoxia group than in the normoxia group (P ≤ 0.01, 0.001, and 0.001, respectively). Myeloperoxidase and protein carbonyls (PC) were higher (P = 0.03 and P = 0.01, respectively) and superoxide dismutase (SOD) was lower in the lung homogenates of the hyperoxia group (P ≤ 0.001). Conclusion Higher myeloperoxidase, PC, and cytokine levels, and lower SOD availability indicate a greater degree of injury in the lungs of the hyperoxia animals, possibly from using 100% oxygen. In this translational study using a pig model, FiO2 ≤ 50% during OLV reduced hyperoxic injury and improved function in the lungs.

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“…Our group has studied the effects of protective ventilation with 5 ml/kg of tidal volume as a strategy to alleviate this injury (43,44) Tidal volume in this study was used as a variable that we controlled. To target a normal end-tidal CO2 and PaCO2, we maintained a tidal volume of approximately 10 ml/kg (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Surfactant administration prior to one lung ventilation: Physiological and inflammatory correlates in a piglet model

Bhatia

Shaffer

Hossain

et al. 2011

Pediatric Pulmonology

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Summary Objectives To test the hypothesis that surfactant, when given prophylactically during one lung ventilation, improves physiological stability and reduces inflammation. Methods Prospective controlled animal study. After 30 minutes of mechanical ventilation, surfactant was administered to the left lung of the treatment group. Right lung mechanical ventilation continued for 3 hours, after which the left lung was unblocked. Bilateral mechanical ventilation was continued for 30 minutes thereafter. Physiological parameters and biomarkers of inflammation in plasma, lung tissue homogenates, and bronchoalveolar lavage were measured. Measurements and Main Results Oxygenation improved in the surfactant group, reaching statistical significance at 3 hours of one lung ventilation and again after 30 minutes of bilateral mechanical ventilation following the one lung ventilation. Plasma levels of interleukin-1 β, interleukin-6, and tumor necrosis factor-α showed a trend for reduction. The lung homogenates from the ventilated lungs had significantly lower levels of interleukin-1 β (P < 0.01) and interleukin-6 (P < 0.01). The bronchoalveolar lavage specimen showed an overall reduction in the cytokine levels; interleukin-1 β was significantly lower in the ventilated lungs (P < 0.01). Conclusions Surfactant administration improves oxygenation and decreases inflammation, as evidenced by a decrease in several inflammatory cytokines both in the plasma and lungs of a piglet model of one lung ventilation.

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Low dose methylprednisolone prophylaxis to reduce inflammation during one‐lung ventilation

Cited by 13 publications

References 29 publications

Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial

Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial

Hyperoxia during one lung ventilation: Inflammatory and oxidative responses

Surfactant administration prior to one lung ventilation: Physiological and inflammatory correlates in a piglet model

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