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. DESIGN:: Randomized, prospective, double-blind, placebo-controlled clinical trial. SETTING:: Children's Hospital of Michigan, intensive care unit. PATIENTS:: Thirty-two children <2 yrs of age with congenital heart disease requiring cardiopulmonary bypass. INTERVENTIONS:: 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. MEASUREMENTS AND MAIN 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.