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/FiO2 were 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.Conclusion:Nebulized budesonide improved oxygenation, peak, and plateau airway pressures and significantly reduced inflammatory markers (TNF-α, IL-1β and IL-6) without affecting hemodynamics.Trial Registry:Australian New Zealand Clinical Trial Registry (ANZCTR) at the number: ACTRN12615000373572.

Effects of ulinastatin combined with mechanical ventilation on oxygen metabolism, inflammation and stress response and antioxidant capacity of ARDS

“…In addition, ulinastatin can inhibit the proteolytic enzyme activity widely and improve body microcirculation and tissue perfusion functions ( 17 ). The stability of intracellular lysosomal membrane ( 18 ) can help improve the organelle mitochondrial activity, improve cell respiration ( 19 ), enhance cell elastinase activity, and remove the body oxygen or hydroxyl-free radicals ( 20 ).…”

Future Trends in Nebulized Therapies for Pulmonary Disease

“…Inhaled glucocorticoids present a significant opportunity to manage the developing inflammatory process in ARDS patients. Preclinical studies have demonstrated improvements in indices of histological injury in a porcine ARDS model [105], while significantly reduced inflammatory markers and improved oxygenation were found after administration of nebulized budesonide in acute lung injury (ALI) patients [106]. In a further pharmacologic attempt to attenuate inflammation in ARDS, nebulized heparin has attenuated inflammation and reduced damage in a preclinical model of ALI [107].…”

Clinical trials of inhaled beclomethasone and mometasone for COVID‐19 should be conducted

“…Nebulized budesonide improved oxygenation and significantly reduced inflammatory markers (tumor necrosis factor-α, interleukin 1β [IL-1β], and IL-6) in patients with acute respiratory distress syndrome. 5 There are several reviews of inhaled corticosteroids for COVID-19, but there is no clear evidence on whether the premorbid use of ICS has adverse or beneficial outcomes in COVID-19 patients. 6,7 ICS can reach different sites in the lungs, depending on their particle sizes.…”