Efficacy of budesonide and interleukin-10 in an experimental rat model with isolated bilateral pulmonary contusion created by blunt thoracic trauma

Effect of vitamin C and vitamin E on lung contusion: A randomized clinical trial study

There is association between lung contusion (lC) and a progressive inflammatory response. The protective effect of vitamin C and vitamin E, as strong free radical scavengers on favourite outcome of (LC) in animal models, has been confirmed.

Design

to evaluate the effect of vitamins, E and C on arterial blood gas (ABG) and ICU stay, in (LC), with injury severity score (ISS) 18 ± 2, due to blunt chest trauma.

Methods

This study was a randomized, double-blind, placebo-controlled clinical trial. Patients with (ISS) 18 ± 2 blunt chest trauma, who meet criteria, participated in the study. A total of 80 patients from Feb 2015 to Jun2018and were randomly divided into 4 groups. Patients received intravenous vitamin E (1000IU mg), was (group I); intravenous vitamin C (500) (group II). Vitamin C + vitamin E = (group III), and intravenous distilled water = (control group) or (group IV). ABG, serum cortisol, and CRP levels were determined at baseline, 24 h and 48 h after the intervention.

Results

a significant decrease in ICU stay in group III compared to other groups (p < 0.001). Co-administration of vitamin C and vitamin E showed significant increases pH (values to reference range from acidemia”), oxygen pressure, and oxygen saturation in group III compared to other groups (p < 0.001). A significant decrease in carbon dioxide pressure was also detected after receiving vitamin C and vitamin E in group III, compared to other groups (p < 0.001). There was no significant difference cortisol and CRP levels between groups after the intervention.

Conclusion

Co-administration of vitamin C and vitamin E, improve the ABG parameters and reduce ICU stay.

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Most previous studies about pulmonary contusion were performed on animal model, this is a human study in surgery ICU.

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Administration of vitamin C and vitamin E showed protective effects on pulmonary contusion, co-administration of them also was more effective.

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PH values, oxygen pressure, and oxygen saturation was significantly increase in group III compared to other groups (p < 0.001). carbon dioxide pressure also was significantly decrease in group III.

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Mean ICU stay in group III (co-administration of vit C + E compare with control group, significantly decreased, p < 0.001).

Lung protective effects of budesonide nebulization during perioperative period of thoracolumbar fusion

OBJECTIVE

To determine the pulmonary protective effect of budesonide nebulization in patients undergoing spinal fusion for thoracolumbar degenerative disorders.

METHODS

Forty patients who underwent spinal fusion at our hospital from January 2013 to December 2013 for the treatment of thoracolumbar degenerative disorders were randomly allocated into a budesonide intervention group (budesonide group) and a control group. The control group received routine supportive therapy including rehydration, analgesia, and neurotrophic drug treatment; in addition to these, the budesonide group was administered with budesonide nebulization (1-mg budesonide/2-mL saline, twice daily) from 1 day preoperatively through 3 days postoperatively. Respiratory symptoms, arterial blood gas, and pulmonary complication before and after the operations were observed and compared between the two groups.

RESULTS

The patients ranged in age from 46 to 81 years old (mean, 62.4±9.4 years), and comprised 20 men and 20 women. There were no significant differences in postoperative body temperature, heart rate, and respiratory rate between the groups (P>0.05). The change in arterial partial pressure of oxygen (PaO2) from baseline was significantly lower in the budesonide group than in the control group (at 2.4±12.4 vs. 16.0±11.3 mmHg) (P=0.002), so was the findings for oxygen saturation (SpO2) (0.2%±2.3% vs. 2.6%±3.3%), respectively (P=0.047). The incidence of postoperative pulmonary symptoms and complications, such as coughing, shortness of breath, and dyspnea, was 0% in the budesonide group and 15% in the control group; overall, the budesonide group performed better than control group in all pulmonary parameters. None of the patients in the budesonide group experienced severe events associated with glucocorticoid therapy.

CONCLUSIONS

Perioperative budesonide nebulization may reduce the postoperative pulmonary complications in middle-aged and elderly patients undergoing thoracolumbar fusion to treat thoracolumbar degeneration, with favorable efficacy and safety.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg⁻¹·day⁻¹), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.