Abstract
BackgroundWhole Lung Lavage (WLL) has been an important part in the management of Pulmonary Alveolar Proteinosis (PAP) since it improves radiologic and clinical parameters. Bilateral WLL is usually performed in two sessions on different days. Few case reports have described one-session bilateral sequential lung lavage (OSBSWLL), and none have described ambulatory management (same-day discharge).MethodsDemographic characteristics, physiologic parameters, procedure details and outcomes were retrospectively collected on consecutive patients who underwent OSBSWLL for PAP following an ambulatory protocol stablished in our institution.ResultsA total of 13 patients underwent 30 OSBSWLL (61.5% male; mean age 40). The mean SpO2 was 90% (IQR 9) and 94% (IQR 6), before and after OSBSWLL respectively. In 63.3% of cases, patients were discharged home the same day of procedure. Only in two cases (6.6%), patients required post-procedure prolonged mechanical ventilation (> 4 h) due to persistent hypoxia.ConclusionsOSBSWLL can be performed with same-day discharge.
Highlights
Pulmonary Alveolar Proteinosis (PAP) was recognized by Rosen in 1958 [1]
We retrospectively reviewed the medical records of patients who underwent Whole Lung Lavage (WLL) due to Pulmonary Alveolar Pro‐ teinosis (PAP) from 1994 until 2013 at Henry Ford Hospital
Assessment of vital signs, including pulsoximetry, as well as Results Thirteen patients underwent a total of 30 OSBSWLL
Summary
Pulmonary Alveolar Proteinosis (PAP) was recognized by Rosen in 1958 [1]. It is a rare entity with a prevalence between 3.2 to 6.7 cases per million [2, 3]. Whole Lung Lavage (WLL), first described by RamirezRivera in 1965 [7], is currently the first line therapy for PAP This procedure is performed to remove the excess surfactant proteins and lipids from the alveolar spaces in order to improve gas exchange. We believe that OSBSWLL is safe to perform, comfortable for the patient, and could reduce costs of a second procedural session. Per our knowledge, this is the largest case series of OSBSWLL reported. Whole Lung Lavage (WLL) has been an important part in the management of Pulmonary Alveolar Pro‐ teinosis (PAP) since it improves radiologic and clinical parameters. Few case reports have described one-session bilateral sequential lung lavage (OSBSWLL), and none have described ambulatory management (same-day discharge)
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