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Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a
Mary C Theroux1, Alicia Olivant Fisher, Maria E Rodriguez
1Department 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.
Insights
A single dose of methylprednisolone given before one lung ventilation (OLV) improved physiological stability in children. This intervention reduced respiratory complications and modulated inflammatory markers, indicating its potential to minimize lung injury during OLV.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery
- Pharmacology
Background:
- One lung ventilation (OLV) can cause significant inflammatory and mechanical lung injury in children, leading to complications.
- Currently, no interventions are established to mitigate OLV-induced lung injury in pediatric patients.
Purpose of the Study:
- To investigate the efficacy of a single pre-operative dose of methylprednisolone in reducing lung injury and improving physiological stability during OLV in children.
- To test the hypothesis that methylprednisolone administration 45-60 minutes before lung collapse would minimize injury.
Main Methods:
- A randomized, placebo-controlled trial involving 28 children undergoing OLV.
- Participants received either 2 mg·kg(-1) methylprednisolone (MP) or a saline placebo prior to OLV.
- Physiological parameters (bronchospasm, resistance, compliance) and plasma inflammatory markers were monitored.
Main Results:
- The methylprednisolone group exhibited lower respiratory resistance compared to the placebo group (P=0.04).
- Pro-inflammatory IL-6 levels were significantly lower, and anti-inflammatory IL-10 levels were higher in the methylprednisolone group (P=0.01 and P=0.001, respectively).
- Lower tryptase levels were observed in the methylprednisolone group post-OLV (P=0.03), with no reported side effects.
Conclusions:
- A single 2 mg·kg(-1) dose of methylprednisolone prior to OLV enhances physiological stability in pediatric patients.
- Methylprednisolone effectively reduces pro-inflammatory markers and increases anti-inflammatory markers, suggesting a protective role against OLV-induced lung injury.
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.
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