PDF(Pubmed)
Abstract：
Whole lung lavage (WLL) has been recognized as the most effective therapy of severe pulmonary alveolar proteinosis (PAP). Most centers perform the lavage of each lung in two sessions under general anesthesia at an interval of several days to weeks. Compared with two-session WLL, one-session bilateral sequential WLL only requires general anesthesia once. However, the safety of one-session WLL in PAP patients has not been assessed by large cohort studies. In this study, we aimed to investigate the association between the mode of WLL procedure (one-session or two-session) and the risk of periprocedural complications in PAP patients.
In this single-center retrospective cohort study, we included adult patients who were diagnosed as PAP and had undergone WLL procedures under general anesthesia from 2000 to 2022. Patients requiring extra-corporeal oxygenation during WLL were excluded. Since some patients received multiple WLL procedures, we considered each procedure in one-session or two-session group as a unique unit in our analysis. The primary outcome was the occurrence of any complications during hospitalization, including termination of WLL procedure due to fluid leakage or refractory hypoxemia, bronchospasm, delayed endotracheal extubation, cardiovascular event, pneumothorax, and fever.
We included a total of 175 WLL procedures (118 patients), with 48 in the two-session group and 127 in the one-session group. Periprocedural complications occurred in 17 (35.4%) and 39 (30.7%) procedures in the two-session and the one-session groups, respectively. The risk of periprocedural complications did not differ significantly between groups, after adjusting the unbalanced confounders in a multivariable model (odds ratio 0.95, 95% confidence interval 0.34 to 2.69, P 0.929) or by inverse probability of treatment weighting (odds ratio 0.70, 95% confidence interval 0.30 to 1.54, P 0.379). Compared with the two-session WLL group, the one-session WLL group had a shorter postprocedural length of hospitalization and comparable decrease in alveolar-arterial oxygen tension gradient from baseline.
One-session bilateral WLL was not associated with an increased risk of periprocedural complications compared with two-session WLL in PAP patients. Experienced physicians may consider performing one-session WLL in view of the comparable safety and efficacy and potential advantages of saving time.
In this single-center retrospective cohort study, we included adult patients who were diagnosed as PAP and had undergone WLL procedures under general anesthesia from 2000 to 2022. Patients requiring extra-corporeal oxygenation during WLL were excluded. Since some patients received multiple WLL procedures, we considered each procedure in one-session or two-session group as a unique unit in our analysis. The primary outcome was the occurrence of any complications during hospitalization, including termination of WLL procedure due to fluid leakage or refractory hypoxemia, bronchospasm, delayed endotracheal extubation, cardiovascular event, pneumothorax, and fever.
We included a total of 175 WLL procedures (118 patients), with 48 in the two-session group and 127 in the one-session group. Periprocedural complications occurred in 17 (35.4%) and 39 (30.7%) procedures in the two-session and the one-session groups, respectively. The risk of periprocedural complications did not differ significantly between groups, after adjusting the unbalanced confounders in a multivariable model (odds ratio 0.95, 95% confidence interval 0.34 to 2.69, P 0.929) or by inverse probability of treatment weighting (odds ratio 0.70, 95% confidence interval 0.30 to 1.54, P 0.379). Compared with the two-session WLL group, the one-session WLL group had a shorter postprocedural length of hospitalization and comparable decrease in alveolar-arterial oxygen tension gradient from baseline.
One-session bilateral WLL was not associated with an increased risk of periprocedural complications compared with two-session WLL in PAP patients. Experienced physicians may consider performing one-session WLL in view of the comparable safety and efficacy and potential advantages of saving time.
摘要：
背景：全肺灌洗（WLL）已被认为是严重肺泡蛋白沉积症（PAP）最有效的治疗方法。大多数中心在全身麻醉下以几天至几周的间隔分两次对每个肺进行灌洗。与两节WLL相比，一次性双侧序贯WLL只需要全身麻醉一次。然而,大型队列研究尚未评估PAP患者使用一次性WLL的安全性.在这项研究中,我们旨在调查PAP患者的WLL手术模式(1次或2次)与围手术期并发症风险之间的关系.
方法：在这项单中心回顾性队列研究中，我们纳入了2000~2022年被诊断为PAP并在全身麻醉下接受WLL手术的成年患者.排除在WLL期间需要体外氧合的患者。因为有些病人接受了多次WLL手术,在我们的分析中,我们将单会话或双会话组中的每个程序视为一个独特的单元.主要结果是住院期间任何并发症的发生，包括由于液体泄漏或难治性低氧血症而终止WLL手术，支气管痉挛,延迟气管内拔管，心血管事件,气胸,和发烧。
结果：我们共纳入了175例WLL手术（118例患者），在两个会话组中有48个，在一个会话组中有127个。在两个疗程和一个疗程组中，17例（35.4％）和39例（30.7％）发生了围手术期并发症。分别。两组围手术期并发症的风险没有显着差异，在多变量模型(比值比0.95,95%置信区间0.34~2.69,P0.929)或治疗加权的逆概率(比值比0.70,95%置信区间0.30~1.54,P0.379)中调整不平衡混杂因素后.与两节WLL组相比，一次性WLL组的术后住院时间较短,肺泡-动脉氧张力梯度较基线降低相当.
结论：在PAP患者中，与两次WLL相比，一次双侧WLL与围手术期并发症的风险增加无关。鉴于可比的安全性和有效性以及节省时间的潜在优势，经验丰富的医生可以考虑进行一次WLL。
方法：在这项单中心回顾性队列研究中，我们纳入了2000~2022年被诊断为PAP并在全身麻醉下接受WLL手术的成年患者.排除在WLL期间需要体外氧合的患者。因为有些病人接受了多次WLL手术,在我们的分析中,我们将单会话或双会话组中的每个程序视为一个独特的单元.主要结果是住院期间任何并发症的发生，包括由于液体泄漏或难治性低氧血症而终止WLL手术，支气管痉挛,延迟气管内拔管，心血管事件,气胸,和发烧。
结果：我们共纳入了175例WLL手术（118例患者），在两个会话组中有48个，在一个会话组中有127个。在两个疗程和一个疗程组中，17例（35.4％）和39例（30.7％）发生了围手术期并发症。分别。两组围手术期并发症的风险没有显着差异，在多变量模型(比值比0.95,95%置信区间0.34~2.69,P0.929)或治疗加权的逆概率(比值比0.70,95%置信区间0.30~1.54,P0.379)中调整不平衡混杂因素后.与两节WLL组相比，一次性WLL组的术后住院时间较短,肺泡-动脉氧张力梯度较基线降低相当.
结论：在PAP患者中，与两次WLL相比，一次双侧WLL与围手术期并发症的风险增加无关。鉴于可比的安全性和有效性以及节省时间的潜在优势，经验丰富的医生可以考虑进行一次WLL。
