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Trends and Outcomes of Patients With Pulmonary Alveolar Proteinosis Undergoing Whole Lung Lavage: A Nationwide Analysis From 2000 to 2009 FREE TO VIEW

Samih Mawari, MD; Ryan Schroeder, MD; Lewandoski Lewandoski, DO; Awani Deshmukh, MD; Ahmed Shahryar, MD; Gagan Kumar, MD
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Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI

Chest. 2014;146(4_MeetingAbstracts):376A. doi:10.1378/chest.1991124
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SESSION TITLE: Interstitial Lung Disease Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary alveolar proteinosis (PAP) is a rare disease in which surfactant composed of proteins and lipids accumulate in pulmonary alveoli. The outcomes have improved with whole lung lavage. The outcomes of whole lung lavage are described for large centers only. We hypothesize that there has been increase usage of this procedure in other hospitals in United States. We describe trends and outcomes of PAP patients undergoing whole lung lavage

METHODS: We used Nationwide Inpatient Sample from 2000 to 2009 to identify patients with PAP using ICD-9-CM code 516.0. We identified whole lung lavage using ICD-9-CM code 33.99. We examined the hospital characteristics like - location, bedsize, teaching status where these procedures were performed. We also examined the in hospital mortality and complications like requirement of invasive mechanical ventilation, tracheostomy and chest tubes associated with whole lung lavage. We used variance weighted least squares method to compare the trends of utilization of whole lung lavage.

RESULTS: There were 477 patients with PAP who underwent whole lung lavage from 2000 to 2009. The procedures were performed in 30 different hospitals. Of these 27 were teaching hospitals and 3 were non teaching hospitals. Mean age was 40.7 years (SD 13.1 years). 295 were females. The number of whole lung lavage increased from 2000 to 2002 (p=0.008) and then remained similar through the years 2002 to 2009. The overall mortality in those undergoing whole lung lavage was 1%. 15.1% of those undergoing whole lung lavage required invasive mechanical ventilation and less than 1% required tracheostomy and chest tubes. The rates of IMV did not change with time.

CONCLUSIONS: The use of whole lung lavage has been stable through years 2002 onwards and has spread to more hospitals. The complication rates are low with less than 1% requiring tracheostomy and chest tubes.

CLINICAL IMPLICATIONS: Whole lung lavage is a safe option for patients with PAP.

DISCLOSURE: The following authors have nothing to disclose: Samih Mawari, Ryan Schroeder, Lewandoski Lewandoski, Awani Deshmukh, Ahmed Shahryar, Gagan Kumar

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