Bilateral Whole Lung Lavage in the Treatment of Pulmonary Alveolar Proteinosis

Abstract

oxygen, 1% sevoflurane, and fentanyl 2-4 g/kg. No patients responded when the abdominal incision was made. However, four patients had transient increases in heart rate and six patients had transient increases in arterial blood pressure during the intraabdominal procedure. The abdominal wall was relaxed without muscular relaxants.No patients complained of postoperative pain immediately after awakening from anesthesia. Postoperative pain management consisted of a continuous IV infusion of fentanyl (20 g/h) for the first day, supplemented with flurbiprofen on the second day in three patients. The averages of visual analog scale (VAS) scores on each day were 23, 49, and 31 on the first, second, and third postoperative days, respectively.The clinical course in these patients suggests that the intercostal nerves were effectively blocked by this technique. The bilateral rectus abdominis muscles were relaxed, no patients showed signs of poor analgesia on the abdominal incision, and VAS scores on the first postoperative day suggested reasonable levels of analgesia. We suggest that this technique may merit further evaluation in clinical trials.

"Crazy-paving" pattern: A characteristic presentation of pulmonary alveolar proteinosis and a review of the literature from India

“…In 16/30 patients information regarding classification either as idiopathic or secondary was not available. [ 15 16 17 18 19 20 22 23 24 25 29 32 33 34 37 38 ] The disease was classified as idiopathic in 9/30 patients[ 21 27 28 30 31 ] and in five patients as secondary PAP. [ 14 26 28 35 36 ] Our patient too was classified as idiopathic.…”

“…[ 26 ] In three patients information regarding the diagnostic modality was not available. [ 19 25 33 ]…”

“…WLL as a therapeutic modality was used in 18/30 patients[ 17 19 20 21 22 23 25 27 28 29 31 32 36 37 38 ] while serial lobar lung lavage was done in one patient. [ 30 ] Of these 18 patients, seven in addition received GM-CSF therapy.…”

“…[ 28 ] In all patients who had undergone WLL, response to therapy was considered to be satisfactory. [ 17 19 20 21 22 23 25 27 28 29 31 32 36 37 38 ] In patients who had received GM-CSF therapy in addition to WLL, it could not be ascertained whether the response to therapy was due to WLL or due to GM-CSF. [ 28 29 30 32 37 ] The only patient who had received GM-CSF therapy alone showed clinical response but had no radiological improvement.…”

“…[ 26 ] Treatment resulted in remarkable improvement in 25/30 patients. [ 16 17 19 20 21 22 23 25 27 28 29 30 31 32 33 34 35 36 37 38 ] In one patient, information regarding the treatment modality was not available[ 18 ] while two other patients were lost to follow-up. [ 14 15 ] Our patient too was lost to follow-up.…”