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[Whole lung lavage in an infant with pulmonary alveolar proteinosis and literature review].
Zhonghua Er Ke Za Zhi. 2020 Jan 02; 58(1):46-50.ZE

Abstract

Objective:

To investigate the safety, feasibility and operation key points of whole lung lavage in infants with pulmonary alveolar proteinosis.

Methods:

The clinical manifestations, genetic screening, therapeutic interventions and outcome of an infant with pulmonary alveolar proteinosis complicated with respiratory failure who received whole lung lavage in November 2018 in Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were reported. Websites including PubMed, Springer Link, China National Knowledge Infrastructure (CNKI), Weipu Database, and Wanfang Database were searched using the key words of "whole lung lavage" "pediatric" and "pulmonary alveolar proteinosis" for articles published from their establishments to April 2019. Relevant literature was reviewed.

Results:

A 3-month-old boy had experienced cough, shortness of breath and cyanosis for 1 week prior to admission to pediatric intensive care unit. Physical examination showed hepatosplenomegaly. Complete blood cell count showed mild anemia (hemoglobin 96 g/L) and normal white blood cells. The patient had normal C-reactive protein and normal blood platelet. Biochemical panel showed hypoalbuminemia (31 g/L), mildly elevated glutamic oxaloacetic transaminase (115 U/L) and blood ammonia (165 μmol/L), extremely elevated lactate dehydrogenase (>6 600 U/L) and hyperferritinemia (>4 500 μg/L). Chest computed tomography (CT) revealed decreased transmittance of both lungs, patchy high density shadow and ground glass opacity. Genetic testing revealed a mutation of c.625+1G>A in SLC7A7. Schiff reaction (PAS staining) in bronchoalveolar lavage fluid was positive. The patient was diagnosed with severe pneumonia, respiratory failure, lysinuria urinary protein intolerance, and pulmonary alveolar proteinosis. The patient received sequential unilateral whole lung lavage in 2 days and was successfully weaned from ventilator. He was discharged home breathing room air. Eleven articles (11 in English and non in Chinese) were reviewed. Twenty-one patients were included. After whole lung lavage, 76% (16/21) of the patients had improvement in respiratory function.

Conclusions:

Whole lung lavage can effectively improve respiratory failure caused by pulmonary alveolar proteinosis in infant patients. The procedure is feasible and safe.

Authors+Show Affiliations

Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.Department of Anesthesiology, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.

Pub Type(s)

Journal Article
Review

Language

chi

PubMed ID

31905476

Citation

An, K, et al. "[Whole Lung Lavage in an Infant With Pulmonary Alveolar Proteinosis and Literature Review]." Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics, vol. 58, no. 1, 2020, pp. 46-50.
An K, Bai J, Gu HB, et al. [Whole lung lavage in an infant with pulmonary alveolar proteinosis and literature review]. Zhonghua Er Ke Za Zhi. 2020;58(1):46-50.
An, K., Bai, J., Gu, H. B., Chen, H. L., Li, B. R., Ning, B. T., Wang, Y., & Qian, J. (2020). [Whole lung lavage in an infant with pulmonary alveolar proteinosis and literature review]. Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics, 58(1), 46-50. https://doi.org/10.3760/cma.j.issn.0578-1310.2020.01.011
An K, et al. [Whole Lung Lavage in an Infant With Pulmonary Alveolar Proteinosis and Literature Review]. Zhonghua Er Ke Za Zhi. 2020 Jan 2;58(1):46-50. PubMed PMID: 31905476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Whole lung lavage in an infant with pulmonary alveolar proteinosis and literature review]. AU - An,K, AU - Bai,J, AU - Gu,H B, AU - Chen,H L, AU - Li,B R, AU - Ning,B T, AU - Wang,Y, AU - Qian,J, PY - 2020/1/7/entrez PY - 2020/1/7/pubmed PY - 2020/1/15/medline KW - Bronchoalveolar lavage KW - Infant KW - Pulmonary alveolar proteinosis SP - 46 EP - 50 JF - Zhonghua er ke za zhi = Chinese journal of pediatrics JO - Zhonghua Er Ke Za Zhi VL - 58 IS - 1 N2 - Objective: To investigate the safety, feasibility and operation key points of whole lung lavage in infants with pulmonary alveolar proteinosis. Methods: The clinical manifestations, genetic screening, therapeutic interventions and outcome of an infant with pulmonary alveolar proteinosis complicated with respiratory failure who received whole lung lavage in November 2018 in Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were reported. Websites including PubMed, Springer Link, China National Knowledge Infrastructure (CNKI), Weipu Database, and Wanfang Database were searched using the key words of "whole lung lavage" "pediatric" and "pulmonary alveolar proteinosis" for articles published from their establishments to April 2019. Relevant literature was reviewed. Results: A 3-month-old boy had experienced cough, shortness of breath and cyanosis for 1 week prior to admission to pediatric intensive care unit. Physical examination showed hepatosplenomegaly. Complete blood cell count showed mild anemia (hemoglobin 96 g/L) and normal white blood cells. The patient had normal C-reactive protein and normal blood platelet. Biochemical panel showed hypoalbuminemia (31 g/L), mildly elevated glutamic oxaloacetic transaminase (115 U/L) and blood ammonia (165 μmol/L), extremely elevated lactate dehydrogenase (>6 600 U/L) and hyperferritinemia (>4 500 μg/L). Chest computed tomography (CT) revealed decreased transmittance of both lungs, patchy high density shadow and ground glass opacity. Genetic testing revealed a mutation of c.625+1G>A in SLC7A7. Schiff reaction (PAS staining) in bronchoalveolar lavage fluid was positive. The patient was diagnosed with severe pneumonia, respiratory failure, lysinuria urinary protein intolerance, and pulmonary alveolar proteinosis. The patient received sequential unilateral whole lung lavage in 2 days and was successfully weaned from ventilator. He was discharged home breathing room air. Eleven articles (11 in English and non in Chinese) were reviewed. Twenty-one patients were included. After whole lung lavage, 76% (16/21) of the patients had improvement in respiratory function. Conclusions: Whole lung lavage can effectively improve respiratory failure caused by pulmonary alveolar proteinosis in infant patients. The procedure is feasible and safe. SN - 0578-1310 UR - https://www.unboundmedicine.com/medline/citation/31905476/[Whole_lung_lavage_in_an_infant_with_pulmonary_alveolar_proteinosis_and_literature_review]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&issn=0578-1310&year=2020&vol=58&issue=1&fpage=46 DB - PRIME DP - Unbound Medicine ER -