Chest
Selected ReportsPulmonary Alveolar Proteinosis: Treatment by Bronchofiberscopic Lobar Lavage
Section snippets
Materials and Methods
Three patients in whom PAP had been diagnosed by open-lung biopsy were enrolled in the study. Blood gases and pulmonary function were measured at the time of hospital admission (Table 1). Bronchoscopic lavage was performed under local anesthesia, with 2% xylocaine given to the patient before and when needed during the FOB. No parenteral sedation or analgesia was used. While the patient breathed oxygen through a nasal cannula, a bronchoscope was passed through the nose and was placed in a
Case 1
A 36-year-old man, a cigarette smoker of 20 pack-years, was brought to our emergency department due to progressive shortness of breath for 6 months and intermittent fever for 5 days. He had been a cement worker for 10 years. He was tachypneic and cyanotic. There were coarse rales over bilateral lower lung fields. A chest radiograph (Fig 1) disclosed diffuse alveolar infiltrates predominantly in the lower lobes. Arterial blood gas analysis on the patient's arrival in the emergency department
Discussion
Whole-lung lavage is now considered to be the most effective treatment for PAP. The major adverse effect of whole-lung lavage is hypoxemia, especially during the emptying phase, which decreases airway pressure and increases the perfusion of the lavaged lung.1112 Hemodynamic instability may develop during a whole-lung lavage,1113 which may necessitate invasive BP monitoring and may further complicate the course of treatment. Noninvasive hemodynamic monitoring by bioimpedance has been found to be
References (28)
- et al.
Contrasting mechanisms for suppression of macrophage cytokine release by transforming growth factor-β and interleukin-10
J Biol Chem
(1992) - et al.
Mice deficient for the IL-3/GM-CSF/IL-5 beta c-receptor exhibits lung pathology and impaired immune response, while beta IL-3 receptor-deficient mice are normal
Immunity
(1995) - et al.
Pulmonary alveolar phospholipoproteinosis: experience with 34 cases and a review
Mayo Clin Proc
(1987) - et al.
Lobar lavage: therapeutic benefit in pulmonary alveolar filling disorders
Chest
(1974) - et al.
Alveolar proteinosis: lobar lavage by fiberoptic bronchoscopic technique
Chest
(1976) - et al.
Fiberoptic bronchopulmonary lavage for alveolar proteinosis in a patient with only one lung
Chest
(1982) - et al.
Pulmonary artery and noninvasive hemodynamics during lung lavage in primary alveolar proteinosis
Chest
(1994) - et al.
Update on the clinical diagnosis, management, and pathogenesis of pulmonary alveolar proteinosis (phospholipidosis)
Chest
(1984) - et al.
A comparison of manual to mechanical chest percussion for clearance of alveolar material in patients with pulmonary alveolar proteinosis (phospholipidosis)
Chest
(1993) - et al.
Pulmonary alveolar proteinosis
Br J Dis Chest
(1969)
Pulmonary alveolar proteinosis
N Engl J Med
Defective lung macrophages in pulmonary alveolar proteinosis
Ann Intern Med
Quantity and structure of surfactant proteins vary among patients with alveolar proteinosis
Am J Respir Crit Care Med
Hematopoietic and lung abnormalities in mice with a null mutation of the common â subunit of the receptors for granulocyte-macrophage colony-stimulating factor and interleukins 3 and 5
Proc Natl Acad Sci U S A
Cited by (69)
Whole-Lung Lavage—a Narrative Review of Anesthetic Management
2022, Journal of Cardiothoracic and Vascular AnesthesiaA case of autoimmune pulmonary alveolar proteinosis with severe respiratory failure treated with segmental lung lavage and oral statin therapy
2022, Respiratory Medicine Case ReportsWhole-lung Lavage and Pulmonary Alveolar Proteinosis: Review of Clinical and Patient-centered Outcomes
2019, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The authors believe a consistent and standardized approach to WLL is beneficial in the perioperative management of this complex patient population. Bilateral, sequential WLL was completed most frequently in this series (90%), but single-lung lavage or segmental lung lavage also has been described.28,29 Order of lung lavage (right v left) is a matter of debate and varies among clinical practice at various centers.16,17
Pulmonary alveolar proteinosis in adults: pathophysiology and clinical approach
2018, The Lancet Respiratory MedicineCitation Excerpt :Since the first iterations of WLL, therapeutic WLL has evolved into the modern-day practice of single or sequential bilateral lavage by isolating each lung with a double-lumen endotracheal tube under general anaesthesia.67 Segmental lung lavage is also done through the bronchoscope (repeated bronchoalveolar lavage) in some centres, but the inferior adequacy of this technique, as well as the arduous nature of the procedure, has relegated it to situations in which WLL is not available.68 WLL is done under general anaesthesia.
Pulmonary Alveolar Proteinosis Syndrome
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionPulmonary alveolar proteinosis
2014, Revue des Maladies Respiratoires