Therapeutic Whole-Lung Lavage for Pulmonary Alveolar Proteinosis

Abdelmalak, Basem; Khanna, Ashish K.; Culver, Daniel A.; Popovich, Marc J.

doi:10.1097/lbr.0000000000000180

Cited by 36 publications

(54 citation statements)

References 31 publications

(35 reference statements)

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“…Complications in our study occurred in 33% of patients overall, with an immediate drop of SaO 2 during the procedure in 12.1% of patients as in other studies [15]. In 1 case, a loss of bronchial isolation was reported with no serious consequences (procedure prolongation) [15], and in another case a methicillin-resistant Staphylococcus aureus pneumonia was noted but successfully treated.…”

Section: Discussionsupporting

confidence: 51%

“…This difference may be explained by the variability of the disease severity of the included patients in the different series, as well as by the fact that many of our patients had undergone other therapies previous to WLL, with secondary relapse [21]. A second lavage is common to complete the initial therapeutic approach [15,22,23], as in our series where 13 (39.4%) patients underwent a second lavage, while another 3 (9%) had multiple WLL. Seymour and Presneill [6] in their analysis showed the effectiveness of WLL to improve survival in this patient population: in a group of 146 patients, the mean rate of survival at 5 years was 94% with lavage as compared to 85% without lavage, and this difference was statistically significant ( p = 0.04).…”

Section: Discussionmentioning

confidence: 99%

“…In 1 case, a loss of bronchial isolation was reported with no serious consequences (procedure prolongation) [15], and in another case a methicillin-resistant Staphylococcus aureus pneumonia was noted but successfully treated. One patient reported headache and fever without evidence of infection, probably due to anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…The technique varies between our centers: only 36.4% used percussion during the procedure when it seemed to be recommended [14,15], some centers used flexible bronchoscopy instead of selective intubation, and in 1 case flexible bronchoscopy under local anesthesia was used [16]. Flexible bronchoscopy is indicated when a patient cannot tolerate general anesthesia or presents with less severe disease, or in pediatric cases [16,17,18].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Whole-Lung Lavage in Pulmonary Alveolar Proteinosis: A Multicenter International Study of GELF

Gay¹,

Wallaert

Nowak³

et al. 2017

Respiration

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Background: New therapies have emerged in the treatment of pulmonary alveolar proteinosis (PAP) and, therefore, there is a real need to evaluate the efficacy of whole-lung lavage (WLL) in this rare disease. Objectives: The aim of this study was to assess the efficacy of WLL in patients with PAP. Methods: We included 33 patients from 12 centers, which are members of the French-Speaking Thoracic Endoscopy Group, for analysis. Data collection concerned patients and disease characteristics, pulmonary function tests (PFTs) and technical information on the procedure. Results: The median age of the patients was 44 years (range 13-77). There were 23 (71.9%) patients with respiratory insufficiency at presentation. All patients underwent WLL by general anesthesia and selective lung ventilation, except 1 who underwent awake flexible bronchoscopy. We noted differences in the technique, as 12 (36.36%) patients had percussion during the procedure and only 4 (12.1%) patients underwent 2-lung lavage during 1 anesthesia. A median of 12 L was used to perform WLL (1.0-40 L). Complications occurred in 11 (33.3%) patients, and 18 (56.25%) of them relapsed in a median period of 16.9 months. No significant changes were found in any PFT parameters studied, except for PaO₂, which was significantly improved by 6.375 mm Hg (p = 0.0213) after the procedure compared to before. Conclusions: Although the application of the WLL technique was variable, overall, it significantly improved patients' short-term respiratory condition by improving PaO₂. However, a long-term effect needs to be confirmed, as many of our patients relapsed.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Whole-Lung Lavage in Pulmonary Alveolar Proteinosis: A Multicenter International Study of GELF

Gay¹,

Wallaert

Nowak³

et al. 2017

Respiration

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“…[11,22,23] However, the severe hypoxemia in PAP patients and the difficulty of the technique have limited its application to medical centers and to more advanced cases. [24] The clinical course and prognosis with or without bronchoalveolar lavage are variable.…”

Section: Discussionmentioning

confidence: 99%

Whole lung lavage for pulmonary alveolar proteinosis: still the most up-to-date treatment

Laçin¹,

Yıldızeli²,

Eryüksel³

et al. 2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada, pulmoner alveoler proteinozlu hastalarda tüm akciğer lavajının lavaj öncesi ve sonrası kan gazı analizi değerlerindeki önemi değerlendirildi.Ça lış m a pla nı: Ocak 1998 -Mayıs 2010 tarihleri arasında Marmara Üniversitesi Hastanesi Göğüs Cerrahisi bölümünde girişimsel teknikler ile pulmoner alveoler proteinoz tanısı konulan dokuz hastanın (1 erkek, 8 kadın; ort. yaş 38.2 yıl; dağılım 29-60 yıl) verileri incelendi. Hastaların lavaj öncesi solunum fonksiyon testleri, lavaj öncesi ve sonrası kan gazı analizleri ve radyolojik görüntüleri değerlendirildi. Tüm hastalarda restriktif solunum paterni ve bozulmuş gaz değişimi tespit edildi ve tüm akciğer lavajı uygulandı. Bul gu lar:Tüm akciğer lavajı sırasında majör komplikasyon görülmedi. Her akciğer 15-30 L serum fizyolojik solüsyonu ile yıkandı. Hastalar ortalama 2.6 gün (dağılım, 1-16 gün) entübe olarak yoğun bakım ünitesinde takip edildi. Ortalama yoğun bakım yatış süresi 3.5 gün (dağılım, 1-16 gün) idi. Bir hasta beşinci lavajından 16 gün sonra perkütan trakeostomi açılırken solunum durması nedeniyle kaybedildi. Lavaj sonrası oksijen parsiyel basıncı ve oksijen satürasyonlarının yükselmesi istatistiksel olarak anlamlı idi. Bütün hastalarda subjektif düzelme görüldü.So nuç: Deneyimimize göre, lavaj protokolüne tamamen uyulursa tüm akciğer lavajı güvenilir bir tekniktir. Lavaj sonrası semptomatik düzelme hızlıdır ve oksijenizasyon anlamlı düzeyde iyileşir.Anah tarsöz cük ler: Hipoksi; pulmoner alveoler proteinoz; tüm akciğer lavajı. ABSTRACTBackground: This study aims to evaluate the significance of whole lung lavage on prelavage and postlavage blood gas analysis values of patients with pulmonary alveolar proteinosis.

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Artificial stone‐associated silicosis with concurrent Cryptococcus infection

Shen

Lai

Tsai

et al. 2021

Respirology Case Reports

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Acute silicoproteinosis is a disease that develops in weeks, and lasting for years, after massive exposure to silica dust in relatively closed spaces. It was rare, but the cases have recently increased worldwide due to the development of artificial stone industry. Compared with traditional silicosis, artificial stone‐associated silicosis is more rapidly progressive and lethal. Hence, a correct diagnosis and optimal treatment are crucial. Here, we present the clinical course of a 33‐year‐old artificial stonemason who suffered from acute silicoproteinosis with concurrent Cryptococcus infection resulting in profound respiratory failure. This patient was treated by bronchoscope‐assisted therapeutic segmental lung lavage and antifungal agent, under mechanical ventilator and ECMO support and recovered well. A brief review of acute silicoproteinosis and artificial stone‐associated silicosis is also presented and highlights the new form of industry exposure to silica.

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Therapeutic Whole-Lung Lavage for Pulmonary Alveolar Proteinosis

Cited by 36 publications

References 31 publications

Efficacy of Whole-Lung Lavage in Pulmonary Alveolar Proteinosis: A Multicenter International Study of GELF

Efficacy of Whole-Lung Lavage in Pulmonary Alveolar Proteinosis: A Multicenter International Study of GELF

Whole lung lavage for pulmonary alveolar proteinosis: still the most up-to-date treatment

Artificial stone‐associated silicosis with concurrent Cryptococcus infection

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