CORTICOSTEROID BY AEROSOL IN SEPTIC PIGS - EFFECTS ON PULMONARY-FUNCTION AND OXYGEN-TRANSPORT

Objective: To assess effects of nebulized corticosteroid on lung funct ion in sepsis. Design: Randomized, placebo-controlled, blinded study i n septic pigs. Setting: A trauma research laboratory. Materials: 16 ju venile pigs, one excluded due to pulmonary hypertension at baseline. I nterventions: Mechanical ventilation and continuous light anesthesia. Brief infusion of live Staph. aureus (4x10(10) cfu) followed by nebuli zation of beclomethasone dipropionate (BDP) 50 mug/kg (n = 8) or place bo (n = 7) 30 and 360 min after start of septic challenge. Measurement s and results: Vascular pressures, cardiac output, lung mechanics, gas exchange and oxygen transport variables were measured at regular inte rvals. An identical transient rise in mean pulmonary artery pressure w as seen in both groups (mean +/- SD: 48 +/- 4 mmHg), followed by a gra dual increase in pulmonary vascular resistance, reaching maximum at 4 h but significantly reduced by BDP compared to placebo (p < 0.01, ANOV A). Mean systemic arterial pressure, arterial oxygen tension and lung compliance did not change significantly in the BDP group, but they all declined in the placebo-group (p < 0.01 compared to baseline, p < 0.0 5 - 0.01 between the groups). Oxygen delivery, decreased significantly in the placebo group at 12 h (p < 0.05). Oxygen extraction increased in both groups (p < 0.01 compared to baseline), being significantly hi gher in the placebo group at 12 h (p < 0.05). Conclusion: Nebulized co rticosteroid protects pulmonary function in sepsis, indicating a thera peutic role in the treatment of septic ARDS.