Issues in Pulmonary NursingPulmonary alveolar proteinosis: Step-by-step perioperative care of whole lung lavage procedure*
Section snippets
Methods
A countrywide survey was conducted during which pulmonologists were questioned about patients with PAP. All patients included had typical clinical and chest x-ray findings and PAP confirmed histologically by a pathologist. Progressive effort intolerance or significant hypoxemia on room air while exercising (oxygen saturation, 90%) were indications to perform WLL. Prelavage assessment included medical history (with emphasis on possible exposure to dust), physical examination, and chest x-ray. In
Whole lung lavage
The WLL team included at least 1 anesthesiologist, a pulmonologist, a nurse, and a physiotherapist. WLL was performed with the patient lying in the supine position in an intensive care bed (with the ability to change patient position as required). The bed was located in the middle of the room to enable a convenient approach from all sides of the patient during the procedure. The following additional equipment was prepared and carefully checked before the procedure by the nursing team: an
Statisticsal analysis
The results were analyzed using the paired t test and are expressed as mean ± standard deviation (SD).
Patients
Five patients with PAP (3 males; mean age, 36 ± 6 years; range, 32-46 years) were included in the study. All were Jewish immigrants of North African ethnic origin. All patients were nonsmokers and 1 had a history of exposure to industrial aluminum dust. Other clinical tests that included PPD and serologic tests for immunologic disorders were negative in all patients.
Whole lung lavage
The 5 patients underwent 10 WLL procedures cumulatively. Anesthetic time lasted 240 ± 56 minutes. Induction (including intubation,
Discussion
Despite the small number of patients and lack of previous experience, therapeutic WLL using lung separation with a double-lumen tube was successfully performed. After the lavage, all patients had marked subjective improvement. Objectively, resting and exercise oxygen saturation, FEV1, and FVC consistently improved (20%-32%), but total lung capacity and the diffusion capacity showed less consistent improvement (Fig 3).
PAP may result from defective clearance of phospholipids by the alveolar
Conclusion
In contrast to other interstitial lung diseases, PAP is sometimes amenable to effective treatment. However, because of the rarity of the disease, many medical centers lack experience in this procedure. Although retrospective and based on a small sample, our results suggest that WLL may be performed safely and effectively if strict adherence to the guidelines and physiologic principles described earlier is maintained. In this regard, maximal cooperation between different team members is crucial
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