Increased Efficacy of Whole Lung Lavage Treatment in Alveolar Proteinosis Using a New Modified Lavage Technique.
Journal
Journal of bronchology & interventional pulmonology
ISSN: 1948-8270
Titre abrégé: J Bronchology Interv Pulmonol
Pays: United States
ID NLM: 101496866
Informations de publication
Date de publication:
01 Jul 2021
01 Jul 2021
Historique:
received:
16
07
2020
accepted:
17
11
2020
entrez:
21
6
2021
pubmed:
22
6
2021
medline:
30
10
2021
Statut:
ppublish
Résumé
Autoimmune pulmonary alveolar proteinosis is an ultra-rare pulmonary disease. Whole lung lavage (WLL) is considered the gold standard therapy. We report a protocol for a new modified lavage technique (nMLT) in which controlled repetitive manual hyperinflation (MH) and intermittent chest percussion are used to enhance WLL efficacy. We included all subjects with autoimmune pulmonary alveolar proteinosis treated with nMLT between 2013 and 2018. nMLT consisted of repetitive MH with intermittent chest percussion every third wash. We reported: instilled volume, protein concentration, and optical density using spectrophotometry. Pulmonary function (FVC %predicted and DLCO %predicted) at start of nMLT was recorded. Data are displayed as mean (±SD), median [interquartile range], or number (%). Comparisons within individuals were made using Students t test. We included 11 subjects (64% male) in whom a total of 67 nMLTs were performed. One nMLT consisted of 15 [12-18] washes. Protein removal was 9.80 [7.52-12.66] g per nMLT. After the first, second, and third cycle of 3 washes, 56% [49% to 61%], 81% [77% to 84%], and 91% [88% to 94%] of the final protein yield was removed, respectively. Optical density was measured 116 times and increased from 1.13 (±0.52) to 1.31 (±0.52) after MH (P<0.001). Efficacy of WLL seems to be enhanced by applying MH every 3 washes. Our technique of WLL with nMLT could be used to increase the amount of protein recruited while instilling the lung with the smallest volume of fluid as possible.
Sections du résumé
BACKGROUND
BACKGROUND
Autoimmune pulmonary alveolar proteinosis is an ultra-rare pulmonary disease. Whole lung lavage (WLL) is considered the gold standard therapy. We report a protocol for a new modified lavage technique (nMLT) in which controlled repetitive manual hyperinflation (MH) and intermittent chest percussion are used to enhance WLL efficacy.
METHODS
METHODS
We included all subjects with autoimmune pulmonary alveolar proteinosis treated with nMLT between 2013 and 2018. nMLT consisted of repetitive MH with intermittent chest percussion every third wash. We reported: instilled volume, protein concentration, and optical density using spectrophotometry. Pulmonary function (FVC %predicted and DLCO %predicted) at start of nMLT was recorded. Data are displayed as mean (±SD), median [interquartile range], or number (%). Comparisons within individuals were made using Students t test.
RESULTS
RESULTS
We included 11 subjects (64% male) in whom a total of 67 nMLTs were performed. One nMLT consisted of 15 [12-18] washes. Protein removal was 9.80 [7.52-12.66] g per nMLT. After the first, second, and third cycle of 3 washes, 56% [49% to 61%], 81% [77% to 84%], and 91% [88% to 94%] of the final protein yield was removed, respectively. Optical density was measured 116 times and increased from 1.13 (±0.52) to 1.31 (±0.52) after MH (P<0.001).
CONCLUSION
CONCLUSIONS
Efficacy of WLL seems to be enhanced by applying MH every 3 washes. Our technique of WLL with nMLT could be used to increase the amount of protein recruited while instilling the lung with the smallest volume of fluid as possible.
Identifiants
pubmed: 34151899
doi: 10.1097/LBR.0000000000000741
pii: 01436970-202107000-00008
pmc: PMC8219085
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
215-220Informations de copyright
Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Disclosure: There is no conflict of interest or other disclosures.
Références
Borie R, Danel C, Debray MP, et al. Pulmonary alveolar proteinosis. Eur Respir Rev. 2011;20:98–107.
Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med. 2003;349:2527–2539.
Frémond ML, Hadchouel A, Schweitzer C, et al. Successful haematopoietic stem cell transplantation in a case of pulmonary alveolar proteinosis due to GM-CSF receptor deficiency. Thorax. 2018;73:590–592.
Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis: progress in the first 44 years. Am J Respir Crit Care Med. 2002;166:215–235.
Tazawa R, Inoue Y, Arai T, et al. Duration of benefit in patients with autoimmune pulmonary alveolar proteinosis after inhaled granulocyte-macrophage colony-stimulating factor therapy. Chest. 2014;145:729–737.
Huaringa AJ, Francis WH. Pulmonary alveolar proteinosis: a case report and world literature review. Respirol Case Reports. 2016;4:1–6.
Campo I, Luisetti M, Griese M, et al. Whole lung lavage therapy for pulmonary alveolar proteinosis: a global survey of current practices and procedures. Orphanet J Rare Dis. 2016;11:1–10.
Tazawa R, Ueda T, Abe M, et al. Inhaled GM-CSF for pulmonary alveolar proteinosis. N Engl J Med. 2019;381:923–932.
Gay P, Wallaert B, Nowak S, et al. Efficacy of whole-lung lavage in pulmonary alveolar proteinosis: a multicenter international study of GELF. Respiration. 2017;93:198–206.
Ramirez J, Schultz R, Dutton R. Pulmonary alveolar proteinosis: a new technique and rationale for treatment. Arch Intern Med. 1963;112:419–431.
Ramirez J. Bronchopulmonary lavage. New techniques and observations. Dis Chest. 1966;50:581–588.
Bonella F, Bauer PC, Griese M, et al. Wash-out kinetics and efficacy of a modified lavage technique for alveolar proteinosis. Eur Respir J. 2012;40:1468–1474.
Inoue Y, Trapnell BC, Tazawa R, et al. Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan. Am J Respir Crit Care Med. 2008;177:752–762.
Bingisser R, Kaplan V, Zollinger A, et al. Whole-lung lavage in alveolar proteinosis by a modified lavage technique. Chest. 1998;113:1718–1719.
Paschen C, Reiter K, Stanzel F, et al. Therapeutic lung lavages in children and adults. Respir Res. 2005;6:138.
Ceruti M, Rodi G, Stella GM, et al. Successful whole lung lavage in pulmonary alveolar proteinosis secondary to lysinuric protein intolerance: a case report. Orphanet J Rare Dis. 2007;2:1–7.
Onodera T, Nakamura M, Sato T, et al. Biochemical characterization of pulmonary washings of patients with alveolar proteinosis, interstitial pneumonitis and alveolar cell carcinoma. Tohoku J Exp Med. 1983;139:245–263.
Xu R, Lian Y, Li WX. Airway complications during and after general anesthesia: a comparison, systematic review and meta-analysis of using flexible laryngeal mask airways and endotracheal tubes. PLoS One. 2016;11:1–19.
Phan K, Kim JS, Kim JH, et al. Anesthesia duration as an independent risk factor for early postoperative complications in adults undergoing elective ACDF. Global Spine J. 2017;7:727–734.
Beccaria M, Luisetti M, Rodi G, et al. Long-term durable benefit after whole lung lavage in pulmonary alveolar proteinosis. Eur Respir J. 2004;23:526–531.
Bonella F, Bauer PC, Griese M, et al. Pulmonary alveolar proteinosis: new insights from a single-center cohort of 70 patients. Respir Med. 2011;105:1908–1916.
Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.