NDLI: Whole lung lavage decreases physiological dead space in patients with pulmonary alveolar proteinosis: two case reports

Content Provider	Springer Nature : BioMed Central
Author	Fujihara, Tatsuya Shono, Atsuko Katayama, Nozomi Nikai, Tetsuro Shiratsuki, Yohei Amano, Yoshihiro Saito, Yoji
Abstract	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 (CO2) production and mixed-expired partial pressure of CO2 breath by breath. In this physiological study, we calculated CO2 elimination per breath (VTCO2,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 VTCO2,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. VTCO2,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.
Related Links	https://jmedicalcasereports.biomedcentral.com/counter/pdf/10.1186/s13256-023-04085-8.pdf
Ending Page	7
Page Count	7
Starting Page	1
File Format	HTM / HTML
ISSN	17521947
DOI	10.1186/s13256-023-04085-8
Journal	Journal of Medical Case Reports
Issue Number	1
Volume Number	17
Language	English
Publisher	BioMed Central
Publisher Date	2023-08-19
Access Restriction	Open
Subject Keyword	Medicine Public Health General Practice Family Medicine Primary Care Medicine Surgical Oncology Internal Medicine Pulmonary alveolar proteinosis Whole lung lavage Carbon dioxide elimination per breath Enghoff’s dead space Medicine/Public Health
Content Type	Text
Resource Type	Case study
Subject	Medicine
Journal Impact Factor	0.9/2023

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