Hyperoxygenated solution for improved oxygen supply in patients undergoing lung lavage for pulmonary alveolar proteinosis

Abstract

Background: At present, the most effective treatment for pulmonary alveolar proteinosis (PAP) remains whole-lung lavage in spite of the usually accompanying severe hypoxemia, which is expected to be prevented by hyperoxygenated solution improving oxygen supply during lavage. In this study, the efficacy and safety of the effect of hyperoxygenated solution were evaluated.

Methods: Five patients underwent whole-lung lavage over a 28-month period. Each lung was lavaged with hyperoxygenated (HO) and normal saline solution (plain lactated Ringer's solution, NO) randomly and alternatively until the reclaimed fluid was clear. Random number was generated by computer before every cycle of lavage. If the number was odd, the patient was assigned to receive a lavage cycle with hyperoxygenated solution (HO group, n = 109); if the number was even, normal saline solution was used (NO group, n = 115). Data of saturation of peripheral oxygen (SPO(2)), mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR) and end-tidal carbon dioxide tension (P(ET)CO(2)) were taken down at 0, 30, 60, 90, 120, 150, 180, 210 and 240 seconds from the beginning of the instillation of solution, and frequency and volume of unilateral lung lavage were also recorded. Time interval between the left and the right lung lavage was 1 week.

Results: No patient was withdrawn from the study due to low SPO(2) or leakage. Oxygen pressure was (730.21 +/- 7.43) mmHg in the hyperoxygenated solution against (175.73 +/- 5.92) mmHg in the normal saline solution (P < 0.01). Compared with baseline, SPO(2) increased significantly as the instillation of solution began (P < 0.01), leveled for about 30 seconds (P > 0.05), and then decreased significantly to the lowest at the time of drainage (compared with 120 seconds or peak, P < 0.01). SPO2 was higher in HO group than in NO group (P < 0.01). There were no significant differences in MAP, HR, CVP and P(ET)CO(2) between HO group and NO group (P > 0.05) and also among different time points (P > 0.05).

Conclusion: During the lung lavage for pulmonary alveolar proteinosis, hyperoxygenated solution could significantly improve oxygen supply in comparison with normal saline solution without obvious side effects.