Utilization and influencing factors of whole lung lavage for patients with pneumoconiosis in Chinese mainland from 2018 to 2021 / 中国职业医学

Objective: To evaluate the utilization and influencing factors of whole lung lavage (WLL) for patients with pneumoconiosis. Methods: A total of 10 524 pneumoconiosis patients who sought medical treatment from 2018 to 2021 were selected as the research subjects using a combination of stratified random sampling and non-random sampling methods. The patients were from 27 provincial administrative regions of Chinese mainland (excluding Shanghai City, Tianjin City, Hainan Province and Tibet Autonomous Region). The effects of demographic and sociological characteristics, disease-related factors, and economic and social security status on WLL utilization were analyzed. Results: The WLL rate of pneumoconiosis patients was 17.8% (1 871/10 524). The main reason for promoting WLL in pneumoconiosis patients was “doctor's advice”, accounting for 65.4%； followed by “known-pneumoconiosis-patients had WLL” and “patient's recommendation”, accounting for 24.1% and 18.1%, respectively. Multivariate logistic regression analysis showed that age, body mass index, smoking index, education level, survey area, source of patients, current employment status, nature of dust-exposed unit, stage of pneumoconiosis, type of pneumoconiosis, pneumoconiosis symptoms (coughing up phlegm, chest pain, dyspnea, joint pain), contraindications to WLL (tuberculosis, pulmonary heart disease), family annual income, medical insurance for urban employees, proportion of medical insurance reimbursement, disability benefits, and social assistance were the influencing factors of WLL utilization in pneumoconiosis patients (all P<0.05). Conclusion: A large proportion of pneumoconiosis patients used WLL. The influencing factors of WLL utilization included demographic and sociological characteristics, disease-related factors, economic and social security status, and more. It is necessary to protect the interests of pneumoconiosis patients, strengthen occupational health education and health promotion for pneumoconiosis patients, standardize the use of WLL in medical institutions, and make rational use of WLL.

Unilateral Presentation of Pulmonary Alveolar Proteinosis

Pulmonary alveolar proteinosis (PAP) is a rare disorder, in which lipoproteinaceous material accumulates within the alveoli. We report a case of a 27-year-old male patient with acute worsening of breathlessness over the last 7�months and cough with desaturation up to 79% on room air. Contrast-enhanced computerized tomography of the thorax revealed unilateral diffuse crazy-paving pattern likely PAP. Transbronchial lung biopsy confirmed the diagnosis of PAP. The present case highlights the unusual presentation of PAP with unilateral involvement. To the best of our knowledge, this is the first reported case of unilateral PAP from India with a biopsy diagnosis and resolution with whole lung lavage.

Lavado pulmonar bilateral terapéutico en una adolescente con proteinosis alveolar pulmonar. A propósito de un caso / Therapeutic bilateral lung lavage in an adolescent with pulmonary alveolar proteinosis. Case report

La proteinosis alveolar pulmonar es una enfermedad pulmonar difusa caracterizada por la acumulación anormal de surfactante y lipoproteínas en el espacio alveolar, lo cual empeora el intercambio gaseoso y lleva a un curso variable desde una presentación clínica asintomática hasta una falla respiratoria grave.Se presenta a una adolescente de 16 años con este diagnóstico que fue remitida a nuestro Hospital para la realización de un lavado pulmonar total luego de una historia de disnea progresiva, dificultad respiratoria, caída de la función pulmonar y anormalidades radiológicas. Se le realizaron estudios de función pulmonar y mediciones de laboratorio antes y después del lavado pulmonar terapéutico.Luego, la paciente presentó una inmediata mejoría tanto de los síntomas, radiografía de tórax y mediciones de estudios de función pulmonar como en el intercambio gaseoso. El lavado pulmonar total continúa siendo el estándar de oro para el tratamiento de la proteinosis alveolar pulmonar en casos graves

Pulmonary alveolar proteinosis is an unusual diffuse lung disease characterized by abnormal accumulation of pulmonary surfactant and lipoproteins in the alveolar space, which impairs gas exchange with a variable clinical course, ranging from an asymptomatic clinical presentation to severely affected respiratory failure.A 16-year-old girl with diagnosis of pulmonary alveolar proteinosis presented to our hospital for therapeutic lung lavage after a recent history of progressive dyspnea, respiratory distress, declining lung function measurements, and worsening radiographic abnormalities. We obtained baseline pulmonary function tests and laboratory measurements before and after therapeutic bilateral lung lavage. After the lavage, the patient demonstrated an immediate improvement in symptoms, chest radiograph appearance, pulmonary function test measurements, as well as in gas exchange. Whole lung lavage is still the gold standard for treatment of pulmonary alveolar proteinosis in severe cases.

Anestesia para reparación antenatal de mielomeningocele: Presentación de un caso / Anesthesia for myelomenigocele antenatal repair: Case report

INTRODUCTION: The advance in the methods of prenatal diagnosis and surgical techniques have allowed the development of fetal surgery, achieving identification and early treatment of anomalies invalidating extrauterine life. Myelomeningocele (MMC) is the most frequent neural tube defect and its intrauterine correction has demonstrated benefits. OBJECTIVE: To publicize the anesthetic management of a prenatal correction of MMC performed in a public hospital in Chile. CASE REPORT: 31-year-old woman, pregnancy of 25 weeks of gestational age, fetus carrying MMC lumbosacral, who underwent open correction. Procedure performed with incidents under general anesthesia with remifentanil and sevoflorane MAC in 2 and tocolytic prophylaxis. At 48 hours post operative, he presented an acute pulmonary edema compatible (EPA), which was successfully resolved with depletive therapy for 24 hours in the Intensive Care Unit, without the need for mechanical ventilation or use of vasoactive drugs. Discharged one week later in good condition, with interruption of pregnancy by elective caesarean section at 37 weeks, with a newborn without stigmas of neurological sequelae. CONCLUSIONS: The mother-fetus binomial is a challenge for the anesthetist. In intrauterine surgery the need for knowledge about the pharmacology of tocolytics, placental uterine physiology and the complications of the procedure are added.

INTRODUCCIÓN: El avance en los métodos de diagnóstico prenatal y las técnicas quirúrgicas han permitido el desarrollo de la cirugía fetal, logrando identificación y tratamiento precoz de anomalías invalidantes para la vida extrauterina. El mielomeningocele (MMC) es el defecto del tubo neural más frecuente y su corrección intrauterina tiene beneficios demostrados. OBJETIVO: Dar a conocer el manejo anestésico de una corrección prenatal de MMC realizada en un hospital público de Chile. CASO CLÍNICO: Mujer de 31 años, embarazo de 25 semanas de edad gestacional, feto portador de MMC lumbosacro, que se sometió a una corrección por vía abierta. Procedimiento realizado con incidentes bajo anestesia general con remifentanilo y sevoflorano MAC en 2 y profilaxis tocolítica. A las 48 horas postoperatorias presentó cuadro compatible con edema pulmonar agudo (EPA), que se resolvió exitosamente con terapia depletiva por 24 horas en Unidad de Cuidados Intensivos, sin necesidad de ventilación mecánica ni uso de drogas vasoactivas. Dada de alta una semana después en buenas condiciones. El embarazo se interrumpió por cesárea electiva a las 37 semanas, con un recién nacido sin estigmas de secuela neurológica. CONCLUSIONES: El binomio madre-feto es un reto para el anestesista. En cirugía intraútero se suma la necesidad de conocimientos sobre la farmacología de los tocolíticos, fisiología útero placentaria y las complicaciones propias del procedimiento.

Whole-lung lavage in a patient with pulmonary alveolar proteinosis

Pulmonary alveolar proteinosis (PAP) is a rare syndrome in which phospholipoproteinaceous matter accumulates in the alveoli leading to compromised gas exchange. Whole-lung lavage is considered the gold standard for severe autoimmune PAP and offers favorable long-term outcomes. In this case report, we describe the perioperative management and procedural specifics of a patient undergoing WLL for PAP in which an anesthesiologist serves as the proceduralist and a separate anesthesiologist provides anesthesia care for the patient.

Effectiveness and safeness of granulocyte macrophage colony stimulating factor and whole lung lavage therapy in idiopathic pulmonary alveolar proteinosis / 药学实践杂志

Objective To observe the effectiveness and safeness of granulocyte macrophage colony stimulating factor (GM-CSF)and whole lung lavage therapy for patients with idiopathic pulmonary alveolar proteinosis(IPAP).Methods Two IPAP patients who were hospitalized in Changhai Hospital from August 2015 to March 2017 were enrolled for the study.Both patients were treated with GM-CSF therapy after whole lung lavage.One patient received GM-CSF by subcutaneous injection and the other by inhalation.Results Both patients'conditions were improved after GM-CSF and whole lung lavage therapy. Conclusion Treatment with subcutaneous injection or inhalation of granulocyte macrophage colony stimulating factor and whole lung lavage is safe and effective for IPAP patients.

Pediatric pulmonary alveolar proteinosis / 中华实用儿科临床杂志

Pulmonary alveolar proteinosis is a rare disease in children.The accumulation of massive amount of lipid and protein in the alveolar can lead to the progressive dyspnea and hypoxemia.The diagnosis could be made with the high resolution computed tomography and pathological findings.Appropriate treatments according to the pathogenesis,together with whole lung lavage,can significantly improve disease outcome.This article will provide a review of the pathogenesis,clinical features,therapeutic approach and disease prognosis of pediatric pulmonary alveolar proteinosis.

Effects of Aerosol Inhalation of Budesonide Combined with Compound Ipratropium Bromide on Therapeu-tic Efficacy of Patients with Pneumoconiosis during Perioperative Period of Massive Whole-lung Lavage / 中国药房

OBJECTIVE:To investigate the effects of aerosol inhalation of budesonide combined with Compound ipratropium bromide on therapeutic efficacy and safety of patients with pneumoconiosis during perioperative period of massive whole-lung la-vage (WLL). METHODS:One hundred and fifty male patients with pneumoconiosis receiving WLL under general anesthesia se-lected from our hospital during Dec. 2014-May 2016 were divided into treatment group and control group in accordance with ran-dom number table,with 75 cases in each group. Both groups received WLL under general anesthesia as well as pure-oxygen manu-al positive pressure ventilation alternating with negative pressure drainage keeping interval and respiratory rate of ventilator synchro-nization. Treatment group was given Budesonide suspension 2 mL,bid+ Compound ipratropium bromide solution 2.5 mL,tid,by aerosol inhalation from 3 d before surgery to 3 d after surgery. The levels of arterial blood gas indexes(pH,PaO2,PaCO2,BE)at different lavage stages,lung function indexes (FVC,MVV,FEV1/FVC),blood gas indexes and clinical symptom score 3 d be-fore surgery and 7 d after surgery were observed in 2 groups,and the occurrence of ADR was recorded. RESULTS:After two-lung ventilation for 20 min following unilateral/bilateral lung lavage,PaO2 of 2 groups were all increased significantly compared to be-fore surgery,with statistical significance (P0.05). three days after surgery,FVC,MVV,FEV1/FVC and PaO2 of 2 groups were all increased significantly,PaCO2 and clinical symptom score were all decreased significantly. FVC,FEV1/FVC,PaO2 and clinical symptom score of treatment group were significantly bet-ter than those of control group,with statistical significance(P<0.05). The incidence of airway spasm,hypoxemia and airway pres-sure increasing in treatment group were significantly lower than in control group,with statistical significance(P<0.05). CONCLU-SIONS:During perioperative period of WLL,the aerosol inhalation of budesonide combined with Compound ipratropium bromide for patients with pneumoconiosis can improve clinical efficacy of WLL and reduce the occurrence of ADR during surgery.

Preemptive analgesia using flurbiprofen combined with dexamethasone for whole lung lavage of pneumoconiosis patients / 中国职业医学

OBJECTIVE: To observe the effect of flurbiprofen( FPA) combined with dexamethasone on preemptive analgesia for whole lung lavage in pneumoconiosis patients. METHODS: Ninety pneumoconiosis patients who underwent whole lung lavage under general analgesia were divided into three groups by random number table method: combine treatment group,FPA group and control group,30 cases in each group. Patients in combine treatment group were given 2 mg/kg body weight( bw) of flurbiprofen axetil injection and 10 mg of dexamethasone through intravenous injection before 2 hours of surgery. Patients in FPA group were given 2 mg/kg bw of FPA axetil injection intravenously. The control group was injected with 2 m L 0. 9% sodium chloride solution. Visual Analogue Scale( VAS) score,Bruggramann Comfort Scale( BCS) score,and adverse reaction of the three groups were recorded in 2,6,8,12 and 24 hours after operation. RESULTS: The postoperative VAS and BCS scores of combine treatment group at the 5 time points after operation were lower than that of control group and FPA group respectively( P < 0. 01). The VAS score between the 5 time points presented an decreasing tendency with the increase of time in the combine treatment group( P < 0. 05),and the BCS score presented an increasing tendency with the increase of time( P < 0. 05). The adverse reaction,such as nausea,vomiting dizziness and drowsiness,sore throat and skin itching in combine treatment group was lower than that of control group and FPA group 24 hours postoperatively( P < 0. 017). CONCLUSION: The therapy of FPA combined with dexamethasone on preemptive analgesia is a safe and effective method for reducing postoperative pain of whole lung lavage in pneumoconiosis patients.

Management of pulmonary alveolar proteinosis with whole lung lavage using extracorporeal membrane oxygenation support in a postrenal transplant patient with graft failure.

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of excessive lung surfactant in the alveoli leading to restrictive lung functions and impaired gas exchange. Whole lung lavage (WLL) is the treatment modality of choice, which is usually performed using double lumen endobronchial tube insertion under general anesthesia and alternating unilateral lung ventilation and washing with normal saline. It may be difficult to perform WLL in patients with severe hypoxemia wherein patients do not tolerate single lung ventilation. Extracorporeal membrane oxygenation support (ECMO) has been used in such patients. We report a patient with autoimmune PAP following renal transplant who presented with marked hypoxemia and was managed by WLL under ECMO support.

The effect of positive pressure ventilation on dust removal in whole lung lavage / 中国职业医学

OBJECTIVE: To explore the effect of positive-pressure ventilation on dust removal in whole lung lavage( WLL).METHODS: By random sample method,21 patients with stage Ⅱ or Ⅲ pneumoconiosis were chosen for different WLL.Using the patients' own left and right lung was used for matched control study. The positive pressure ventilation was performed at the end of the 3rd,6th,9th and 12 th lavage in treatment lung( treatment groups). The positive-pressure ventilation was not implemented at the end of the 3rd and 6th lavage in the contralateral lung( control groups) but implemented at the end of the 9th,11 th and 12 th lavage. The recovery of lavage fluid,dust and dust concentration drained from 4th to 9th lavage were compared in the two groups. RESULTS: There was no statistical difference in the recovery of the lavage fluid in the 4th to 9th lavage in the two groups( P > 0. 05). The amount of dust and the dust concentration in the fourth lavage drainage in the treatment group was higher than that in the control group( P < 0. 01). The amount of dust and the dust concentration in the 6th,8th and 9th lavage drainage in the treatment group was lower than that in control group( P < 0. 01). The amount of dust and the dust concentration in the 3rd positive pressure ventilation were higher than that in the 6th positive pressure ventilation in the treatment group( P < 0. 01). The total amount of dust in the treatment group was higher than that in the the control group( P < 0. 01). CONCLUSION: In whole lung lavage,the positive pressure ventilation can accelerate the discharge of dust in the lung of patients with pneumoconiosis.

The studies on the changes of nitric oxide synthase in the lung tissue of traumatic hemorrhagic shock rats under dry heat environment of desert and their relations to the secondary lung injuris / 中华急诊医学杂志

Objective To study the pathological changes and expressions of NO and iNOS mRNA in the lung tissue of traumatic hemorrhagic shock rats under dry heat environment of desert and their relations to the lung injury.Methods A total of 140 male SD rats were randomly (random number) ivided into the room temperature (25 ℃) environment traumatic hemorrhagic shock group (room temperature group) and the dry heat traumatic hemorrhagic shock groups (dry heat group,temperature 40℃,humidity 10％),respectively,and each groups was further randomly divided into 7 subgroups:the control subgroup,post shock subgroups at 0,0.5,1,1.5,2and 3 h (n =10 in each subgroup).The rats of control subgroup were not treated,and rats of dry heat group were placed in dry heat environment for 60 min,then anesthetized,fixed,and insertion of intravenous indwelling needles and catherization of right carotid artery,jugular vein and the right femoral artery were performed.After stabilization for 10 min,2500 g iron wheel was used to be dropped from 30 m height and vertically hit the upper left femoral of SD rats in order to make comminuted fracture,wounds were quickly dressed after injury.Exsanguination from right femoral artery was kept until MAP maintained at (35 ± 5) mmHg,and resuscitation was carried out after continue monitoring for 60 min.After the establishment of traumatic hemorrhagic shock model in each environment,the rats were sacrificed at given intervals,and thoracotomy was performed to take broncho-alveolar lavage fluid (BALF) and lung tissue.Pathological changes of lung tissues were observed by using HE staining and NO concentration of lung tissue was detected by one-step method,and changes of the iNOS mRNA expressions were detected by using fluorescence quantitative PCR.Then t test,ANOVA and Pearson correlation analysis were used for the data analysis.Results The pathological change in dry heat group at each interval was more severe,and pulmonary histopathological injury score was higher,and the protein exudation was more profuse compared with the room temperature group.NO concentration in lung tissue homogenate of dry heat group was higher than that of room temperature group (t =2.472,P ＜ 0.05),and the difference in NO level between different intervals within the dry heat group was statistically significant (F =6.77,P ＜ 0.01).The NO concentration in dry heat group reached its maximum at 2 h (3.35 ± 0.23) μmol / g and the peak value emerged sooner than that in room temperature group.The difference was statistically significant in overall expression of iNOS mRNA between two groups analyzed with t test (t =3.619,P ＜ 0.01),and there was statistically significant difference between intervals within the dry heat group (F =12.34,P ＜0.01).The values of iNOS mRNA in the dry heat group were higher than those in the room temperature group at the same given intervals,and the peak value appears at 1.5 h in dry heat group,and the room temperature group it began to increase at 2 h.The concentration of NO and the expression of iNOS mRNA were positively correlated with each other in two groups (r =0.680,r =0.376).The expression of iNOS mRNA and lung histopathological injury score was positively correlated in two groups (r =0.846,r =0.899).Conclusions When traumatic hemorrhagic shock occurred in the dry heat desert environment,the lung injury was more severe and appeared sooner than that in the room temperature environment.NO and iNOS played important roles in the secondary lung injury in the wake of traumatic hemorrhagic shock in rats under the dry heat environmengt of desert.

Proteinosis alveolar pulmonar: Una puesta al día / Pulmonary Alveolar Proteinosis: Up to Date

La Proteinosis Alveolar Pulmonar (PAP) es una enfermedad rara, caracterizada por la acumulación de surfactante en el interior del espacio alveolar, resultando en una alteración del intercambio gaseoso. El curso clínico es variable, abarcando desde la resolución espontánea hasta el fallo respiratorio y muerte. Se han descripto tres formas de PAP: genética, secundaria y primaria o idiopática, siendo esta última la más frecuente en la población adulta. Avances en el conocimiento de la fisiopatología de la PAP han demostrado que la forma idiopática es el resultado de la generación de autoanticuerpos anti factor estimulante de colonias granulocito-macrófago (GM-CSF). Todas las formas de PAP resultan en disfunción macrofágica con la acumulación del material lipoproteináceo en el espacio alveolar. La PAP se caracteriza por disnea progresiva, tos seca e hipoxemia. Se encuentran opacidades bilaterales en la radiografía de tórax y la tomografía computada de alta resolución pone de manifiesto vidrio esmerilado con engrosamiento de los septos inter e intralobulillar, conformando el patrón típico en empedrado. Si bien la biopsia quirúrgica es el método de referencia para el diagnóstico definitivo, la combinación de las manifestaciones clínicas características y el lavado broncoalveolar (LBA) con material PAS positivo a menudo son suficientes para establecer el diagnóstico. El tratamiento de elección en primera medida sigue siendo el lavado pulmonar total bajo anestesia general con el objeto de remover el material proteináceo del espacio alveolar y mejorar el intercambio gaseoso. Recientemente, estudios han demostrado que el tratamiento inhalatorio o subcutáneo con GM-CSF podría beneficiar a algunos pacientes con formas idiopáticas de PAP.

Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by the accumulation of surfactant lipids and protein in the alveolar spaces, resulting in impairment in gas exchange. The clinical course can be variable, ranging from spontaneous resolution to respiratory failure and death. There are three forms of PAP: congenital, acquired and idiopathic, being the latter the most prevalent form in the adult population. Advances in the understanding of the pathophysiology of PAP demonstrate that the idiopathic form is due to antigranulocyte macrophage-colony stimulating factor (GM-CSF) antibodies. All the forms of PAP cause macrophage dysfunction leading to accumulation of the proteinaceous material. PAP is characterized by progressive exertional dyspnea and nonproductive cough with hypoxemia. Bilateral infiltrates are typically present on chest radiograph; high-resolution computed tomography reveals diffuse ground-glass opacities and airspace consolidation with interlobular septal thickening in a characteristic “crazy paving” pattern. Although surgical lung biopsy will provide a definitive diagnosis, a combination of typical clinical and imaging features with periodic acid-Schiff (PAS)-positive material on bronchoalveolar lavage and transbronchial biopsies is usually sufficient. The current standard of care is to perform whole lung lavage under anesthesia on these patients to clear the alveolar space to help improving respiratory physiology. Recent studies have demonstrated that GM-CSF (inhalation or subcutaneous) can result in improvement in some patients with idiopathic PAP.

Experience with treatment of pulmonary alveolar proteinosis from a tertiary care centre in north India.

Background. Pulmonary alveolar proteinosis (PAP) is a disorder characterised by accumulation of lipids and proteins in the alveoli, with the resultant symptoms ranging from indolent subclinical disease to progressive respiratory failure. Methods. We retrospectively studied five patients with PAP managed at our center between January 2007 and April 2010, with whole lung lavage (WLL) and/or subcutaneous granulocyte macrophage-colony stimulating factor (GM-CSF) therapy. Patients undergoing WLL under general anaesthesia were supplemented with three months of GM-CSF therapy. Pre- and post-lavage symptom assessment was performed with a 10-point, symptom-based visual analogue scale. Results. Their mean age was 37.6±7.0 years; there were four males. Diagnosis of PAP [idiopathic (n=3); secondary to Nocardia (n=1)] was established by surgical lung biopsy in four patients who presented with respiratory failure. Three patients with idiopathic PAP (n=3) were treated with a combination of GM-CSF and WLL; one patient with secondary PAP was treated with antibiotics alone. In another patient transbronchial lung biopsy was used to diagnose PAP and GM-CSF alone was administered. All patients were followed up for a median period of two years (range 0.5-3 years). Significant improvement was achieved in all the patients with therapeutic WLL and/or GM-CSF. Conclusions. Whole lung lavage appeared to be an effective and safe therapy in patients with PAP. Efficacy of simultaneous administration of GM-CSF and WLL in the treatment of PAP merits further study.

Citologia dos lavados traqueobrônquico (LTB) e broncoalveolar (LBA) de bezerros holandeses sadios durante o primeiro mês de vida / Cytology of tracheobronchial and bronchoalveolar lavage in healthy Holteins calves during the first month of life

O período neonatal dos bezerros é um momento crítico para adaptação do recém-nascido à vida extra uterina e o sistema respiratório, um dos mais exigidos funcionalmente, é frequentemente afetado por enfermidades, redundando no prejuízo direto da sua função e acarretando perdas econômicas importantes na pecuária. O ponto básico para reduzir estas perdas, é representado pela adequada avaliação clínica dos neonatos, todavia o diagnóstico baseado exclusivamente no exame físico é muito difícil de ser estabelecido. O uso de exames complementares como a citologia do trato respiratório torna-se uma ferramenta diagnóstica importante nestes casos, porém faz-se necessário, padronizar seus achados frente às diferentes técnicas empregadas para a sua obtenção. Assim, o presente estudo propôs-se acompanhar as variações dos constituintes celulares da região traqueobrônquica e broncoalveolar obtidos por lavados respiratórios pelos métodos de traqueocentese e por colheita nasotraqueal respectivamente, durante o primeiro mês de vida de bezerros sadios. Observou-se alteração no quadro citológico ao longo do tempo, quando a região traqueobrônquica foi lavada, expresso por diminuição da porcentagem de macrófagos alveolares, com aumento de neutrófilos, possivelmente, por maior irritação local provocada pela técnica, que se repetiu sequencialmente e/ou por maior estimulo de microorganismos inalados depositados nesta região. Na região broncoalveolar, não encontraram-se variações nos constituintes celulares em função do tempo. Os resultados permitiram a conclusão que a população celular da região traqueobrônquica modificou-se ao longo das semanas de vida dos bezerros, possivelmente pela técnica empregada e/ou fisiologia normal da região, sendo representadas por maiores magnitudes de neutrófilos. De modo diverso, na região broncolaveolar, as células evidenciaram um comportamento estável durante o primeiro mês de vida dos bezerros neonatos, apresentando predomínio numérico dos macrófagos alveolares.

The neonatal calf is a critical moment for adaptation of the newborn to extra uterine life. The respiratory tract is functionally very demanded and often affected by disease, resulting in direct loss of their function and causing serious economic losses in livestock. The basic point to reduce these losses is appropriate clinical evaluation of neonates; but the diagnosis based solely in physical examination is very difficult to establish. The use of complementary analysis such cytology of the respiratory tract becomes an important diagnostic tool; however their findings must be standardized in the face of different techniques employed. This research studied the dynamics of the cellularity of the bronchoalveolar and tracheobronchial region obtained through lung lavage harvested by nasotracheal catheterization technique and tracheocenthesis respectively, during the first month of life of healthy calves. The tracheobronchial cytology was influenced by the time, showing decreased number of alveolar macrophages and greater number of neutrophils, possibly increased by local irritation caused by the technique, which was repeated sequentially, and/or through greater stimulation of inhaled microorganisms deposited in this region. In the bronchoalveolar region no variation in the cellular constituents in function of time was found. The results allowed the conclusion the cell population of the tracheobronchial region has changed over the week-old calves, possibly due to the technique used and/or to the normal region physiology, represented by higher magnitudes of neutrophils. Otherwise, the cells of the broncholaveolar region showed a stable behavior during the first month of life of newborn calves, presenting numerical predominance of alveolar macrophages.

Anesthetic Management of Whole-Lung Lavage Using Propofol-Remifentanil in a Patient with Pulmonary Alveolar Proteinosis / 대한구급학회지

Pulmonary alveolar proteinosis (PAP) is characterized by the progressive accumulation of phospholipids and proteins within the alveolar sacs without producing an inflammatory response. Whole-lung lavage (WLL) is performed as the standard therapy for this disease because it serves to wash out the proteinaceous material from the alveoli. In this case, we performed sequential WLL using propofol-remifentanil, which is not related to hypoxic pulmonary vasoconstriction during one-lung ventilation. The patient's symptoms and radiologic findings showed improvement without the occurrence of any specific complications. Therefore, we report a case of anesthetic management of WLL performed repeatedly for a patient with recurrent PAP.

Treatment of smoke inhalation injury by delayed lung lavage with pulmonary surfactant diluent / 中华急诊医学杂志

Objective To investigate the therapeutic effects of delayed lung lavage with exogenous pulmonary surfactant(PS)diluent on endogenous surfactant system dysfunction and acute respiratory failure caused by severe smoke inhalation in rats.Method Ninety Wistar rats were randomly separated into five groups:Group I,normal control(n=14);Group Ⅲ,smoke inhalation(n=27);GroupⅢ,smoke+PS lavage+mechanical ventilation(MV),n=21;Group IV,smoke+saline lavage+MV,n=10;Group V,smoke+MV,n=18.The lungs were lavaged with 30 ml/kg normal ssdine containing 100 mg/kg PS or same volume of saline via tra cheal catheter at 2 h after smoke inhalation,then the animals were placed on a ventilator for 4 h,and observed until 24 h after injury.The arterial blood gas level,lung water volume,static lung compliance(Cst),total protein and albumin contents in bronchoalveolar lavage fluid(BALF),surface tension properties of BALF,and fatality rate at 24 h were measured.Results Smoke inhalation caused a similar acute hypoxia and severe carbon monoxide poisoning immediately in all injured groups.The animals in group Ⅱ showed acute respiratory failure,serious hish permeability pulrnonary edema,and surfactant system dysfunction.The surface tension properties of BALF and Cst were significantly improved by delayed lung lavage treated with exogenous PS diluent in group m(P<0.05).However,the lung water volume,total protein and albumin contents in BALF and the oxygenation had not significant difference between group Ⅲ and group Ⅱ(P>0.05).Conclusions Delayed lung lavage with exogenous PS diluent,at a certain extemt,restored endogenous suffactant function inhibited by smoke inhalation and improved lung function.Nevertheless,the trent could not alleviate rash permeability pulmonary edema and respiratory failure drarnatically.The expected decrease of mortality at early stage after smoke inhalation injury was not showed yet.

Whole Lung Lavage and Extracorporeal Membrane Oxygenation in a Patient with Pulmonary Alveolar Proteinosis and Lung Cancer / 대한마취과학회지

Pulmonary alveolar proteinosis is characterized by accumulation of surfactant phospholipids and proteins within alveoli of the lungs. Sequential whole lung lavage is an accepted modality for treatment of pulmonary alveolar proteinosis. Generally, the degree of hypoxemia is tolerable while only one lung is being ventilated and the other is being lavaged. However, one patient became severely hypoxemic when one lung ventilation was performed through the left lung because of R-to-L shunt due to the lung cancer in the left lower lobe. Therefore, whole lung lavage on the right lung was successfully performed, while utilizing venovenous extracorporeal membrane oxygenation.

Evaluation of a lipid extract surfactant isolated from foam from adult sheep lung lavage

A simple and inexpensive method of isolating surfactant was devised. The in vivo function of surfactant isolated from saline alveolar washes of adult sheep lungs by foam formation using nitrogen gas was evaluated. The foam was organic solvent extracted with chloroform:methanol:saline (2:1:1 v/v) either once or twice. Part of each lipid extract surfactant (LES) was autoclaved. The total phosphorus (TP) and saturated phosphatidylcholine (sat PC) measurements were used to quantify these phospholipids in the LES. The mean sat PC:TP ratio was 0.54 and there were no changes with sterilization. to evaluate in vivo function, surfactant deficient preterm rabbits were treated intratracheally with either 100 mg/kg of the isolated sheep surfactant extracted twice with chloroform:methanol (LES-2), surfactant extracted only once (LES- 1), 4 ml/kg Survanta (S), or air (control, Cx). The rabbits were then ventilated with dital volumes of 8 ml/kg and 3 cm H20 positive and expiratory pressure (PEEP). Ventilation pressures (peak inspiratory pressure-PIP in cm H20, mean +/- SE) of animals treated with LES-2 (14.4 +/- 0.7) were lower (p 0.01) than Cx (22.8 + 0.5) and LES-1 (19.5 + 0.6), and not different from S (14.6 +/- 1.1). Dynamic compliances (ml/cmH20/kg) in animals treated with LES-2 (0.6 +/- 0.0) were higher (p 0.01) than Cx (0.4 +/- 0.0) and LES-1 (0.4 +/- 0.0), and not different from S (0.6 +/- 0.1). The initial inflation pressure from pressure-volume curve measurements was lowest for LES-2 treated animals (p0.01 at 20cm H20). Survanta and LES-2 treated animals retained more volume on deflation than Cx and LES-1 animals (p 0.01 at 0 cm H20). The ventilation and pressure-volume curve measurements for the autoclaved LES and non-autoclaved LES were similar. Based on the invivo performance of the LES, recommendations are made for improvements of the isolation procedure. (Author)

Two cases of Pulmonary Alveolar Proteinosis Improved by Whole Lung Lavage / 결핵

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipid, is deposited on alveoli and bronchioles. Several cases were reported since 1986, and the numbers of patients is increasing in Korea. Although the pathogenesis and causative treatment of PAP is not well known, whole lung lavage is the only consistently successful treatment. We report 2 cases of PAP which were confirmed by open lung biopsy with electron microscopy and clinically improved by whole lung lavage with a review of literature.