Rapid alveolar epithelial fluid clearance following lung lavage in pulmonary alveolar proteinosis.
OBJECTIVE
To measure the in vivo rate of alveolar epithelial fluid clearance of the human lung in patients with pulmonary alveolar phospholipoproteinosis (PAP).


METHODS
Prospective clinical study.


METHODS
The medical-surgical ICUs of a university teaching hospital.


METHODS
Four patients with idiopathic PAP requiring therapeutic lung lavage.


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


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
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.
Chesnutt
M S
MS
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health Sciences University, Portland, OR 97201-3098, USA. chsnutm@ohsu.edu
Nuckton
T J
TJ
Golden
J
J
Folkesson
H G
HG
Matthay
M A
MA
D000328:Adult; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid; D005260:Female; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D011446:Prospective Studies; D011649:Pulmonary Alveolar Proteinosis / Q000378:metabolism / Q000628:therapy*; D011650:Pulmonary Alveoli / Q000378:metabolism*; D012965:Sodium Chloride
D007552:Isotonic Solutions; D012965:Sodium Chloride