title: Rapid alveolar epithelial fluid clearance following lung lavage in pulmonary alveolar proteinosis.
abstract: 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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health Sciences University, Portland, OR 97201-3098, USA. chsnutm@ohsu.edu
authors.forename: M S
authors.initials: MS
authors.lastname: Chesnutt
authors.forename: T J
authors.initials: TJ
authors.lastname: Nuckton
authors.forename: J
authors.initials: J
authors.lastname: Golden
authors.forename: H G
authors.initials: HG
authors.lastname: Folkesson
authors.forename: M A
authors.initials: MA
authors.lastname: Matthay
mesh_terms: 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
chemical_list: D007552:Isotonic Solutions; D012965:Sodium Chloride