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Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports
BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by progressive accumulation of the alveolar surfactant. Whole lung lavage (WLL) using a high volume of warmed saline remains the standard therapy. However, no established bedside monitoring tool can evaluate the physiol...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439532/ https://www.ncbi.nlm.nih.gov/pubmed/37596611 http://dx.doi.org/10.1186/s13256-023-04085-8 |
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author | Fujihara, Tatsuya Shono, Atsuko Katayama, Nozomi Nikai, Tetsuro Shiratsuki, Yohei Amano, Yoshihiro Saito, Yoji |
author_facet | Fujihara, Tatsuya Shono, Atsuko Katayama, Nozomi Nikai, Tetsuro Shiratsuki, Yohei Amano, Yoshihiro Saito, Yoji |
author_sort | Fujihara, Tatsuya |
collection | PubMed |
description | BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by progressive accumulation of the alveolar surfactant. Whole lung lavage (WLL) using a high volume of warmed saline remains the standard therapy. However, no established bedside monitoring tool can evaluate the physiological effect of WLL in the perioperative period. Indirect calorimetry, which is generally used to measure resting energy expenditure, can detect carbon dioxide (CO(2)) production and mixed-expired partial pressure of CO(2) breath by breath. In this physiological study, we calculated CO(2) elimination per breath (VTCO(2),br) and Enghoff’s dead space using indirect calorimetry and measured the extravascular lung water index to reveal the effect of WLL. CASE PRESENTATION: We measured VTCO(2),br, Enghoff’s dead space, and the extravascular lung water and cardiac indices before and after WLL to assess the reduction in shunt by washing out the surfactant. A total of four WLLs were performed in two PAP patients. The first case involved an Asian 62-year-old man who presented with a 3-month history of dyspnea on exertion. The second case involved an Asian 48-year-old woman with no symptoms. VTCO(2),br increased, and the Enghoff’s dead space decreased at 12 h following WLL. An increase in the extravascular lung water was detected immediately following WLL, leading to a transient increase in Enghoff’s dead space. CONCLUSION: WLL can increase efficient alveolar ventilation by washing out the accumulated surfactant. However, the lavage fluid may be absorbed into the lung tissues immediately after WLL and result in an increase in the extravascular lung water. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13256-023-04085-8. |
format | Online Article Text |
id | pubmed-10439532 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-104395322023-08-20 Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports Fujihara, Tatsuya Shono, Atsuko Katayama, Nozomi Nikai, Tetsuro Shiratsuki, Yohei Amano, Yoshihiro Saito, Yoji J Med Case Rep Case Report BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by progressive accumulation of the alveolar surfactant. Whole lung lavage (WLL) using a high volume of warmed saline remains the standard therapy. However, no established bedside monitoring tool can evaluate the physiological effect of WLL in the perioperative period. Indirect calorimetry, which is generally used to measure resting energy expenditure, can detect carbon dioxide (CO(2)) production and mixed-expired partial pressure of CO(2) breath by breath. In this physiological study, we calculated CO(2) elimination per breath (VTCO(2),br) and Enghoff’s dead space using indirect calorimetry and measured the extravascular lung water index to reveal the effect of WLL. CASE PRESENTATION: We measured VTCO(2),br, Enghoff’s dead space, and the extravascular lung water and cardiac indices before and after WLL to assess the reduction in shunt by washing out the surfactant. A total of four WLLs were performed in two PAP patients. The first case involved an Asian 62-year-old man who presented with a 3-month history of dyspnea on exertion. The second case involved an Asian 48-year-old woman with no symptoms. VTCO(2),br increased, and the Enghoff’s dead space decreased at 12 h following WLL. An increase in the extravascular lung water was detected immediately following WLL, leading to a transient increase in Enghoff’s dead space. CONCLUSION: WLL can increase efficient alveolar ventilation by washing out the accumulated surfactant. However, the lavage fluid may be absorbed into the lung tissues immediately after WLL and result in an increase in the extravascular lung water. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13256-023-04085-8. BioMed Central 2023-08-19 /pmc/articles/PMC10439532/ /pubmed/37596611 http://dx.doi.org/10.1186/s13256-023-04085-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Case Report Fujihara, Tatsuya Shono, Atsuko Katayama, Nozomi Nikai, Tetsuro Shiratsuki, Yohei Amano, Yoshihiro Saito, Yoji Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports |
title | Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports |
title_full | Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports |
title_fullStr | Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports |
title_full_unstemmed | Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports |
title_short | Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports |
title_sort | whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439532/ https://www.ncbi.nlm.nih.gov/pubmed/37596611 http://dx.doi.org/10.1186/s13256-023-04085-8 |
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