HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Chesnutt, M. S. Articles by Matthay, M. A. Search for Related Content PubMed PubMed Citation Articles by Chesnutt, M. S. Articles by Matthay, M. A.

Rapid Alveolar Epithelial Fluid Clearance Following Lung Lavage in Pulmonary Alveolar Proteinosis^*

^* From the Division of Pulmonary and Critical Care Medicine (Dr. Chesnutt), Department of Medicine, Oregon Health Sciences University, Portland, OR; the Department of Physiology (Dr. Folkesson), Northeastern Ohio Universities College of Medicine, Rootstown, OH; and the Division of Pulmonary and Critical Care Medicine (Drs. Nuckton, Golden, and Matthay), Departments of Medicine and Anesthesia, and Cardiovascular Research Institute, University of California, San Francisco, CA.

Correspondence to: Mark S. Chesnutt, MD, Division of Pulmonary and Critical Care Medicine, UHN-67, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Rd, Portland, Oregon 97201-3098; e-mail: chesnutm{at}ohsu.edu

Abstract

Study objective: To measure the in vivo rate of alveolar epithelial fluid clearance of the human lung in patients with pulmonary alveolar phospholipoproteinosis (PAP).

Design: Prospective clinical study.

Setting: The medical-surgical ICUs of a university teaching hospital.

Patients: Four patients with idiopathic PAP requiring therapeutic lung lavage.

Interventions: Large-volume lung lavage with isotonic saline solution using fiberoptic bronchoscopy followed by serial sampling of alveolar fluid using a wedged bronchial catheter.

Measurements and results: The rate of alveolar epithelial fluid clearance was calculated by measuring the concentration of protein in sequential samples. Alveolar epithelial fluid clearance over the first hour after lung lavage was 53 ± 14% (mean ± SD). Sequential samples in two patients indicated a sustained high rate of clearance over several hours. Plasma and alveolar fluid epinephrine levels were in the normal range in two patients.

Conclusions and significance: Alveolar fluid clearance is rapid after lung lavage in patients with PAP and appears to be driven by catecholamine-independent mechanisms. The rapid rate of alveolar epithelial fluid transport explains why patients with PAP tolerate large-volume lung lavage.

Key Words: alveolar epithelial fluid transport • lung lavage • pulmonary alveolar phospholipoproteinosis • pulmonary edema

This article has been cited by other articles:

				H. G. Folkesson, C. J. Chapin, L. L. Beard, R. Ertsey, M. A. Matthay, and J. A. Kitterman Congenital diaphragmatic hernia prevents absorption of distal air space fluid in late-gestation rat fetuses Am J Physiol Lung Cell Mol Physiol, March 1, 2006; 290(3): L478 - L484. [Abstract] [Full Text] [PDF]

				A. Perez IV, H. O. Coxson, J. C. Hogg, K. Gibson, P. F. Thompson, and R. M. Rogers Use of CT Morphometry To Detect Changes in Lung Weight and Gas Volume Chest, October 1, 2005; 128(4): 2471 - 2477. [Abstract] [Full Text] [PDF]

				P. A. Dargaville, J. F. Mills, B. M. Headley, Y. Chan, L. Coleman, P. M. Loughnan, and C. J. Morley Therapeutic Lung Lavage in the Piglet Model of Meconium Aspiration Syndrome Am. J. Respir. Crit. Care Med., August 15, 2003; 168(4): 456 - 463. [Abstract] [Full Text] [PDF]