Amount of liquid deficit in whole lung lavage predicts the need for mechanical ventilation

Abstract

complication rate was reported as 16% and the mortality rate as 1.1%. The most common complication after the procedure is fever 9 . Studies are still needed to optimize and standardize the procedure. There are few studies on this subject 11 . This study aimed to evaluate ABSTRACT INTRODUCTION Pulmonary alveolar proteinosis (PAP) is a rare syndrome that causes hypoxemic respiratory failure characterized by accumulation of lipoproteinous material in the alveoli. Whole lung lavage (WLL) is still the standard treatment which is based on the physical removal of the material with saline fluid. This study was aimed to evaluate the technical aspects of WLL procedures and postoperative complications in our unit. METHODS The study is a single-center retrospective study. A total of 83 WLLs performed on 21 PAP patients were evaluated. Saline was infused repetitively through the double-lumen intubation tube leading to the target lung in reverse Trendelenburg position and drained in the Trendelenburg position until the drained fluid became clear. Liquid deficits, complications and intensive care follow-up were recorded. RESULTS In all, 21 patients with a mean age of 38.2 ± 9.8 years underwent WLLs. The median number of procedures per patient was 2, the mean amount of fluid infused through the airways was 11.8 ± 4.3 L, while liquid deficit was 550 mL. Complications such as oxygen desaturation, arrhythmia, bronchospasm, epilepsy secondary to intracranial hemorrhage, pneumonia, and transient neuropathy were observed in 9 procedures; 59 (71.1%) procedures were followed by supplemental oxygen, 17 (20.5%) NIMV and 7 (8.4%) IMV support. The median residual liquid in the supplemental oxygen group was 485.19 ± 387 mL, 646.19 ± 652 mL in NIMV and 14009 ± 1419 mL (p<0.001) in the IMV (invasive mechanical ventilation) group.