Abstract
BackgroundVentilation-induced lung injury (VILI) is a health problem for patients with acute respiratory dysfunction syndrome. The aim of this study was to investigate the effectiveness of budesonide in treating VILI.MethodsTwenty-four rats were randomized to three groups: a ventilation group, ventilation/budesonide group, and sham group were ventilated with 30 ml/kg tidal volume or only anesthesia for 4 hor saline or budesonide airway instillation immediately after ventilation. The PaO2/FiO2and wet-to-dry weight ratios, protein concentration, neutrophil count, and neutrophil elastase levels in bronchoalveolar lavage fluid (BALF) and the levels of inflammation-related factors were examined. Histological evaluation of and apoptosis measurement inthe lung were conducted.ResultsCompared with that in the ventilation group, the PaO2/FiO2 ratio was significantly increased by treatment with budesonide. The lung wet-to-dry weight ratio, total protein, neutrophil elastase level, and neutrophilcount in BALF were decreased in the budesonide group. The BALF and plasma tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, intercellular adhesion molecule (ICAM)-1, and macrophage inflammatory protein (MIP)-2 levels were decreased, whereas the IL-10 level was increased in the budesonide group. The phosphorylated nuclear factor (NF)-kBlevels in lung tissue were inhibited by budesonide. The histological changes in the lung and apoptosis were reduced by budesonide treatment. Bax, caspase-3, and cleaved caspase-3 were down-regulated, and Bcl-2 was up-regulated by budesonide.ConclusionsBudesonide ameliorated lung injury induced by large volume ventilation, likely by improving epithelial permeability, decreasing edema, inhibiting local and systemic inflammation, and reducing apoptosis in VILI.
Highlights
Ventilation-induced lung injury (VILI) is a health problem for patients with acute respiratory dysfunction syndrome
Budesonide improves alveolocapillary permeability and the Wet/dry weight (W/D) weight ratio and total protein in bronchoalveolar lavage fluid (BALF) in VILI We evaluated the effect of budesonide on alveolocapillary permeability in VILI
Budesonide inhibits inflammation in VILI We evaluated the effect of budesonide on inflammationin VILI
Summary
Ventilation-induced lung injury (VILI) is a health problem for patients with acute respiratory dysfunction syndrome. Studies have shown that about 24 % of ARDS patients treated with MV developed ventilator-induced lung injury (VILI) [3], which resulted in a 40–50 % mortality rate [4]. MV with a large volume may lead to alveolar overstretching, increase alveolar-capillary permeability, and cause pulmonary edema [5] and lung focal inflammation [6]. Small tidal volume MV can reduce the lung injury and lower the Studies have shown that the imbalance of pro- and anti-inflammatory cytokines plays a critical role in the pathogenesis of VILI [8, 9]. During VILI, cytokines are released, leucocytes are recruited to the lung, and lung permeability is increased, resulting in lung edema and deterioration of pulmonary gas exchange [10]. The cytokines released from injured endothelial and epithelial can enter the blood and cause systemic inflammation and injury to other organs
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