Improving Oxygenation During Bronchopulmonary Lavage Using Nitric Oxide Inhalation and Almitrine Infusion

Moutafis, M.; Dalibon, Nicolas; Colchen, A; Fischler, Marc

doi:10.1097/00000539-199908000-00008

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…Temporary decrease in SpO 2 resulted from increased blood flow in the lavaged lung during the drainage phase (5,10). Similar to the results of Moutafis et al (8), shunt fractions increased slightly during some periods of drainage compared to OLV without lavage. In spite of increased shunt fraction, arterial oxygenation was within acceptable limits during OLV.…”

Section: Discussionsupporting

confidence: 89%

“…Peak airway pressures were under 35 cm H 2 O during OLV. Emptying of the lung can impair pulmonary gas exchange because the shunt increases (8). We observed slight and transient declines in SpO 2 during sessions of drainage.…”

Section: Discussionmentioning

confidence: 60%

“…MBAL is expected to be associated with an increased risk of hypoxemia in a patient with PAP and the requirement of long-term OLV (7). However, data including intrapulmonary shunt fraction during MBAL is very scarce in the literature (8). In this report, we aim to share our experiences on the management of anesthesia, monitoring and MBAL.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An uncommon procedure for a rare ailment: Massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis

Sazak¹,

Şahin²,

Pehlivanoğlu³

et al. 2012

Balkan Med J

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As a rare procedure, massive bronchoalveolar lavage (MBAL) is a large-volume lavage which necessitates general anesthesia and one-lung ventilation (OLV). During MBAL isotonic saline is instilled into one lung and drained through one lumen of a double-lumen tube. MBAL is the most effective treatment for symptomatic pulmonary alveolar proteinosis (PAP). A 27-year-old male with PAP was scheduled for therapeutic MBALs. After standard preoxygenation, monitoring and anesthesia induction, a double-lumen tube was placed. Tube position was verified by a fiberoptic bronchoscope. The internal jugular vein, radial and pulmonary arteries were cannulated. A temperature probe and foley catheter were inserted. The nonventilated lung was filled with 1000 mL saline and then drained in each session. The left and right lung were lavaged with an interval of 2 weeks. A total of 20 L saline was used in each MBAL without retention. MBALs were terminated after the effluent became clear. Duration of the left and right MBALs were 325 and 275 minutes, respectively. Despite increased shunt fraction, oxygenation was within acceptable limits during OLV. The trachea was extubated in the operating room uneventfully after each MBAL. The patient's clinical and laboratory findings were evidently improved. Consequently, if proper conditions are provided, MBAL is safe and beneficial despite its risks and the long duration.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 60%

See 1 more Smart Citation

An uncommon procedure for a rare ailment: Massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis

Sazak¹,

Şahin²,

Pehlivanoğlu³

et al. 2012

Balkan Med J

View full text Add to dashboard Cite

show abstract

“…These include manual ventilation of partially fluid-filled lung, intermittent double-lung ventilation, and concomitant use of inhaled nitric oxide and almitrine. 30,31 In extremely unstable patients, rescue strategies that have been reported include pulmonary artery occlusion of the nonventilated lung using a pulmonary artery catheter and finally use of hyperbaric oxygen and veno-venous extracorporeal membrane oxygenation. [32][33][34][35] Loss of lung Isolation Leakage of lavage fluid to the nonlavaged lung can occur at any time during the procedure.…”

Section: Complications Hypoxemiamentioning

confidence: 99%

Therapeutic Whole-Lung Lavage for Pulmonary Alveolar Proteinosis

Abdelmalak¹,

Khanna²,

Culver

et al. 2015

Journal of Bronchology &Amp; Interventional Pulmonology

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Pulmonary alveolar proteinosis is a disease caused by increased accumulation and impaired clearance of surfactant by alveolar macrophages. This narrative review summarizes the role of therapeutic whole-lung lavage in the management of pulmonary alveolar proteinosis. We describe the preprocedural evaluation, indications, and anesthetic considerations, along with step-by step technical aspects of the procedure, postoperative recovery, potential complications, and long-term outcomes.

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“…Zwissler et al reported the use of inhaled prostacyclin (PGI 2 ) to treat intraoperative pulmonary hypertension following cardiopulmonary bypass in a newborn with supracardiac total anomalous pulmonary venous connection following surgical repair [9]. Additionally, Moutafis et al reported improved oxygenation following the administration of the vasoconstricting agent, almitrine, during OLV for various clinical indications in adults [10,11]. Although the use of almitrine may have been a therapeutic option for our first patient as the hypoxemia resulted for poor matching of ventilation with perfusion during OLV, in our second patient, the primary problem was increased PVR for which almitrine would not have been effective.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Administration of Nitric Oxide

Dietrich

Tobias

2003

J Intensive Care Med

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Despite its therapeutic efficacy in various clinical scenarios in the intensive care unit setting, there are limited reports regarding the intraoperative applications of nitric oxide (NO). The authors present 2 pediatric patients to whom inhaled NO was administered intraoperatively. In one patient, NO was used to treat hypoxemia that developed after the institution of one-lung ventilation during thoracoscopic resection of a bronchiectatic section of lung. In the second patient, NO was used to alleviate pulmonary hypertension and cardiovascular dysfunction with pulmonary artery cross-clamping for placement of a modified Blalock-Taussig shunt. The potential intraoperative applications and techniques for the intraoperative delivery of NO are presented.

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Improving Oxygenation During Bronchopulmonary Lavage Using Nitric Oxide Inhalation and Almitrine Infusion

Cited by 14 publications

References 25 publications

An uncommon procedure for a rare ailment: Massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis

An uncommon procedure for a rare ailment: Massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis

Therapeutic Whole-Lung Lavage for Pulmonary Alveolar Proteinosis

Intraoperative Administration of Nitric Oxide

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