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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−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. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypothesis that protective ventilation strategy (PVS) as defined by the use of low stretch ventilation (tidal volume of 5 ml·kg−1 and employing 5 cm of positive end expiratory pressure (PEEP) during one lung ventilation (OLV) in piglets would result in reduced injury compared to a control group of piglets who received the conventional ventilation (tidal volume of 10 ml·kg−1 and no PEEP). Background: PVS has been found to be beneficial in adults to minimize injury from OLV. We designed the current study to test the beneficial effects of PVS in a piglet model of OLV. Methods: Ten piglets each were assigned to either ‘Control’ group (tidal volume of 10 ml·kg−1 and no PEEP) or ‘PVS’ group (tidal volume of 5 ml·kg−1 during the OLV phase and PEEP of 5 cm of H2O throughout the study). Experiment consisted of 30 min of baseline ventilation, 3 h of OLV, and again 30 min of bilateral ventilation. Respiratory parameters and proinflammatory markers were measured as outcome. Results: There was no difference in PaO2 between groups. PaCO2 ( P < 0.01) and ventilatory rate ( P < 0.01) were higher at 1.5 h OLV and at the end point in the PVS group. Peak inflating pressure (PIP) and pulmonary resistance were higher ( P < 0.05) in the control group at 1.5 h OLV. tumor necrosis factor-alpha ( P < 0.04) and IL-8 were less ( P < 0.001) in the plasma from the PVS group, while IL-6 and IL-8 were less ( P < 0.04) in the lung tissue from ventilated lungs in the PVS group. Conclusions: Based on this model, PVS decreases inflammatory injury both systemically and in the lung tissue with no adverse effect on oxygenation, ventilation, or lung function. [ABSTRACT FROM AUTHOR]