JMIR Publications

ABSTRACT

Background:

Whole lung lavage (WLL) remains the standard treatment for patients with pulmonary alveolar proteinosis (PAP). However, WLL procedures are not fully standardized, and there is no global consensus on the best approach, such as performing one-session versus two-session WLL.

Objective:

This study aimed to assess and compare the safety and effectiveness of these two methods in a real-world clinical environment.

Methods:

In this retrospective cohort study, we included patients with PAP who underwent WLL at a tertiary hospital in China from September 2009 to May 2024. Patients were categorized into one-session and two-session WLL groups. The primary outcome was the incidence of WLL-related complications. Secondary outcomes included improvements in ΔPaO2, procedure duration, the rate of extubation within 24 hours, length of hospital stay, and hospitalization costs.

Results:

A total of 26 patients with PAP underwent 37 WLL procedures, with 15 procedures in the one-session group (15 patients) and 22 procedures in the two-session group (11 patients). The incidence of WLL-related complications, including acid-base disorders, desaturation, and pleural effusions, did not significantly differ between the groups. However, compared to the two-session WLL group, the one-session group demonstrated significantly greater improvement in ΔPaO2 (14.20 [2.6, 29.2] mmHg vs 2.50 [-3.2, 5.45] mmHg, p=0.015) and shorter hospital stay (10 [7, 14] days vs 18 [10, 26] days, p=0.020). No significant differences were observed in the procedure duration, extubation rate within 24 hours, or hospitalization costs between the groups.

Conclusions:

For patients with PAP, one-session WLL offers comparable safety to two-session WLL, with significantly greater improvement in ΔPaO2 and shorter hospital stays, without increasing hospitalization costs. These results suggest that adopting one-session WLL may optimize patient outcomes and resource utilization in clinical practice.