ALVEOLAR PROTEINOSIS: BRONCHOALVEOLAR LAVAGE EXPERIENCE, CURRENT LITERATURE REVIEW

Year 2024, Volume: 7 Issue: 1, 90 - 100, 29.05.2024

Sercan Aydın , Hasan Yavuz , Ayşegül Çevik Ergönül , Tevfik İlker , Kutsal Turhan , Alpaslan Çakan , Ufuk Çağırıcı

https://doi.org/10.52538/iduhes.1436008

Abstract

Introduction: Bronchoalveolar lavage (BAL) is considered as the first-line therapy for pulmonary alveolar proteinosis (PAP). The points to be kept in mind about the disease and its treatment were reviewed with current research and presented together with our clinical experience on the effectiveness of the BAL procedure.
Methods: Patients with diagnosis of PAP were included. Total of 15 BALs were applied to 6 patients. Preoperative and 3rd postoperative hour arterial blood gas values were recorded. In addition to the partial oxygen pressures (PaO2), the ratio of the difference to the preoperative value was also evaluated and the lavage volumes of all patients were recorded.
Results: A general significant increase in PaO2 was observed compared to pre-treatment. The correlation between the PaO2 change and the lavage volume per side was interpreted as a remarkable result even though statistical significance was not determined.
Conclusion: A positive correlation between PaO2 change and lavage volume were observed. This may be a precursor to the idea that continuing lavage for a while after the lavage fluid has cleared improves the quality of the process.

Keywords

blood gas, bronchoalveolar lavage, alveolar proteinosis

ALVEOLAR PROTEİNOZİS: BRONKOALVEOLAR LAVAJ DENEYİMİ, GÜNCEL LİTERATÜR TARAMA

Abstract

Giriş: Bronkoalveoler lavaj, pulmoner alveolar proteinozis için ilk basamak tedavi olarak kabul edilmektedir. Hastalık ve tedavisiyle ilgili akılda tutulması gereken noktalar güncel literatür eşliğinde gözden geçirilmiş ve lavaj prosedürünün etkinliği konusundaki klinik deneyimlerimizle birlikte sunulmuştur.
Yöntemler: Çalışmaya alveolar proteinozis tanısı alan hastalar dahil edildi. Toplamda 6 hastaya 15 lavaj uygulandı. Preoperatif ve postoperatif 3. saat arteriyel kan gazı değerleri kaydedildi. Parsiyel oksijen basıncına ek olarak, preoperatif-postoperatif değişimler de değerlendirildi ve tüm hastaların lavaj hacimleri kaydedildi.
Bulgular: Tedavi öncesine kıyasla parsiyel oksijen basıncında belirgin bir artış gözlendi. Parsiyel oksijen basıncı değişimi ile lavaj hacmi arasındaki korelasyon, istatistiksel olarak anlamlı olmasa da dikkate değer bir sonuç olarak yorumlandı.
Sonuç: Lavaj sonrası parsiyel oksijen basıncındaki artış oranı ile lavaj hacmi arasında pozitif korelasyon gözlendi. Bu durum lavaj sıvısı berrak hale geldikten sonra bir süre daha işleme devam edilmesinin işlem kalitesini artırabileceği fikrinin bir öncüsü olabilir.

Keywords

kan gazı, bronkoalveoler lavaj, alveolar proteinozis

References

• Alasiri, A.M., Alasbali, R.A., Alaqil, M.A., Alahmari, A.M., Alshamnari, N.D., Badri, R.N. (2021). Autoimmune pulmonary alveolar proteinosis successfully treated with lung lavage in an adolescent patient: a case report. J Med Case Rep, 15(1), 340.
• Bansal, A., Sikri, V. (2013). A case of pulmonary alveolar proteinosis treated with whole lung lavage. Indian J Crit Care Med, 17(5), 314-7.
• Beccaria, M., Luisetti, M., Rodi, G., Corsico, A., Zoia, M.C., Colato, S., Pochetti, P., Braschi, A., Pozzi, E., Cerveri, I. (2004). Long-term durable benefit after whole lung lavage in pulmonary alveolar proteinosis. Eur Respir J, 23(4), 526-31.
• Gay, P., Wallaert, B., Nowak, S., Yserbyt, J., Anevlavis, S., Hermant, C., Lovis, A., Menard, O., Maitre, B., Vandemoortele, T., Dutau, H., Briault, A., Bourdin, A., Vergnon, J.M., Froudarakis, M.E. (2017). Efficacy of Whole-Lung Lavage in Pulmonary Alveolar Proteinosis: A Multicenter International Study of GELF. Respiration, 93(3), 198-206.
• Michaud, G., Reddy, C., Ernst, A. (2009). Whole-lung lavage for pulmonary alveolar proteinosis. Chest, 136(6), 1678-81.
• Misra, S., Das, P.K., Bal, S.K., Elayat, A., Sahoo, S., Dahl, A.B., Kurian, D., Raphael, I.J., Younes, H.A. (2020). Therapeutic Whole Lung Lavage for Alveolar Proteinosis. J Cardiothorac Vasc Anesth, 34(1), 250-7.
• Mo, Q., Wang, B., Dong, N., Bao, L., Xiaoqiong, S., Li, Y., Chen, C. (2016). The Clinical Clues of Pulmonary Alveolar Proteinosis: A Report of 11 Cases and Literature Review. Can Respir J, 4021928.
• Powers, K.J., Avadhanula, V., Patel, P.R., Sarkar, P.K., Piedra, P., Khameh, N.Z. (2022). Whole lung lavage: Treating pulmonary alveolar proteinosis at the time of COVID pandemic. Respir Med Case Rep, 39, 101707.
• Rosen, S.H., Castleman, B., Liebow, A.A., Enzinger, F.M., Hunt, R.T.N. (1958). Pulmonary Alveolar Proteinosis. N Engl J Med, 258, 1123-42.
• Seymour, J.F., Presneill, J.J. (2002). Pulmonary alveolar proteinosis: progress in the first 44 years. Am J Respir Crit Care Med, 166(2), 215-35.
• Smith, B.B., Torres, N.E., Hyder, J.A., Barbara, D.W., Giillespie, S.M., Wylam, ME. (2019). Whole-lung Lavage and Pulmonary Alveolar Proteinosis: Review of Clinical and Patient-centered Outcomes. J Cardiothorac Vasc Anesth, 33(9), 2453-61.
• Silva, A., Moreto, A., Pinho, C., Magalhaes, A., Morais, A., Fiuza, C. (2014). Bilateral whole lung lavage in pulmonary alveolar proteinosis--a retrospective study. Rev Port Pneumol, 20(5), 254-9.
• Suzuki, T., Trapnell, B.C. (2016). Pulmonary Alveolar Proteinosis Syndrome. Clin Chest Med, 37(3), 431-40.
• Vo, T., Chan, J.C.Y., Worthington, M. (2020). How to do whole lung lavage for treatment of pulmonary alveolar proteinosis. ANZ J Surg, 90(5), 877-8.
• Zhou, X., Lu, G., Yu, Z., Gao, F., Bian, T. (2014). Long-term follow-up of whole lung lavage in patients with pulmonary alveolar proteinosis. Exp Ther Med, 8(3), 763-8.