Journal of thoracic disease · 2026
Gravity-driven modified whole-lung lavage improves procedural efficiency in pulmonary alveolar proteinosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Luo Weizhan, Huang Junfeng, Song Xinyu, Zhong Changhao, Chen Xiaobo, Tang Chunli, Lu Liya, Chen Yu, Li Shiyue
Аннотация
BACKGROUND: Whole-lung lavage (WLL) remains the gold standard for symptomatic pulmonary alveolar proteinosis (PAP). However, conventional protocols are resource-intensive, relying on manual chest percussion, frequent position changes, and active negative-pressure suctioning to accelerate effluent drainage. We evaluated a modified gravity-driven workflow designed to improve procedural efficiency by optimizing hydrodynamics and minimizing manual airway manipulation.
METHODS: In this single-center retrospective cohort study, we analyzed 112 WLL procedures performed in 88 patients between October 1, 2007, and April 30, 2024. Procedures were categorized into a classic workflow (n=60; utilizing manual percussion, postural changes, and active negative-pressure suction) or a modified gravity-driven workflow (n=52). The modified technique employed a saline reservoir elevated to 100 cm, fixed supine positioning, and passive gravity drainage through a three-way stopcock to maintain a closed circuit. Primary outcomes included lavage duration, anesthesia duration, and fluid recovery rate. Generalized estimating equations (GEE) were used to adjust for baseline confounders.
RESULTS: Baseline characteristics were balanced between groups. The modified technique demonstrated superior efficiency. Compared with the classic technique, the modified workflow significantly reduced the median lavage duration [135 (interquartile range (IQR), 116-160) vs. 240 min (IQR, 211-360 min); P<0.001] and total anesthesia duration (240 vs. 390 min; P<0.001). The fluid recovery rate was significantly higher in the modified group (95.0% vs. 92.0%; P<0.001). Both techniques showed improvement in oxygenation at discharge, and no statistically significant between-group differences were observed in oxygenation outcomes in this cohort. No statistically significant between-group differences were observed in recorded complications, including pneumothorax, pleural effusion, and hemodynamic instability.
CONCLUSIONS: The gravity-driven modified WLL is an efficient technique. By utilizing increased hydrostatic pressure, this approach significantly reduces procedural time and improves fluid recovery. In this cohort, it was not associated with a detectable difference in short-term oxygenation outcomes or recorded complications.
METHODS: In this single-center retrospective cohort study, we analyzed 112 WLL procedures performed in 88 patients between October 1, 2007, and April 30, 2024. Procedures were categorized into a classic workflow (n=60; utilizing manual percussion, postural changes, and active negative-pressure suction) or a modified gravity-driven workflow (n=52). The modified technique employed a saline reservoir elevated to 100 cm, fixed supine positioning, and passive gravity drainage through a three-way stopcock to maintain a closed circuit. Primary outcomes included lavage duration, anesthesia duration, and fluid recovery rate. Generalized estimating equations (GEE) were used to adjust for baseline confounders.
RESULTS: Baseline characteristics were balanced between groups. The modified technique demonstrated superior efficiency. Compared with the classic technique, the modified workflow significantly reduced the median lavage duration [135 (interquartile range (IQR), 116-160) vs. 240 min (IQR, 211-360 min); P<0.001] and total anesthesia duration (240 vs. 390 min; P<0.001). The fluid recovery rate was significantly higher in the modified group (95.0% vs. 92.0%; P<0.001). Both techniques showed improvement in oxygenation at discharge, and no statistically significant between-group differences were observed in oxygenation outcomes in this cohort. No statistically significant between-group differences were observed in recorded complications, including pneumothorax, pleural effusion, and hemodynamic instability.
CONCLUSIONS: The gravity-driven modified WLL is an efficient technique. By utilizing increased hydrostatic pressure, this approach significantly reduces procedural time and improves fluid recovery. In this cohort, it was not associated with a detectable difference in short-term oxygenation outcomes or recorded complications.