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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Subject(s)
Adult , Bronchoalveolar Lavage , Female , Granulocyte-Macrophage Colony-Stimulating Factor/therapeutic use , Humans , India , Male , Pulmonary Alveolar Proteinosis/pathology , Pulmonary Alveolar Proteinosis/therapy , Retrospective StudiesABSTRACT
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.
Subject(s)
Humans , One-Lung Ventilation , Phospholipids , Proteins , Pulmonary Alveolar Proteinosis , Therapeutic Irrigation , VasoconstrictionABSTRACT
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.
Subject(s)
Humans , Hypoxia , Bronchoalveolar Lavage , Extracorporeal Membrane Oxygenation , Lung Neoplasms , Lung , One-Lung Ventilation , Phospholipids , Pulmonary Alveolar ProteinosisABSTRACT
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.
Subject(s)
Humans , Biopsy , Bronchioles , Bronchoalveolar Lavage , Korea , Lung , Microscopy, Electron , Pulmonary Alveolar ProteinosisABSTRACT
Pulmonary alveolar proteinosis is characterized by the accumulation of PAS positive lipoproteinaceous or amorphous proteinaceous material in the alveolar space with spared delicate septal architecture of the lung interstitium and impaired gas exchange of alveoli. We experienced a case of secondary pulmonary alveolar proteinosis in a 41 year old male patient who have occupational history of engagement as a mason over 4year. He compalined exertional dyspnea and chest discomfort, and presented fine inspiratory crackle at both lower lung field, numerous fine nodular denisties in both lung field with peripheral sparing. Light microscopic finding of lung tissue obtained by transbronchial lung biopsy revealed homogenous eosinophilic colloid-like luminal content in the alveolar space, and electron microscopy of bronchoalveolar lavage fluid concentrate showed electron-dense multilamellated structures. To treat the disease, we tried whole lung lavage of right lung with isotonic saline under general anesthesia. After whole lung lavage of right lung, he showed markid improvement of symptom and partial improvement of chest X-ray findings. The patient has been followed for 12 month until now, with no evidence of aggravation
Subject(s)
Adult , Humans , Male , Anesthesia, General , Biopsy , Bronchoalveolar Lavage , Bronchoalveolar Lavage Fluid , Dyspnea , Eosinophils , Lung , Microscopy, Electron , Phenobarbital , Pulmonary Alveolar Proteinosis , Respiratory Sounds , Silicosis , ThoraxABSTRACT
Pulmonary alveolar proteinosis is characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar sacs in the absence of inflammatory response. Whole-lung lavage is the only consistent treatment for pulmonary alveolar proteinosis. We have utilized whole-lung lavage for the successful treatment of a 62 year-old female patient with pulmonary alveolar proteinosis. There was no persistent complication during the procedure and the postanesthetic recovery except temporary fever and hypoxic event. The patient was symptomatically, physiologically, and radiologically improved within days after the procedures.