THE PHYSIOLOGIC CONSEQUENCES OF SALINE LOBAR LAVAGE IN HEALTHY-HUMAN ADULTS

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Abstract
Acute physiologic sequelae of saline lobar lung lavage were examined in 19 healthy nonsmoking human volunteers. Lavage was conducted through a cuffed fiberoptic bronchoscope using ten 100-ml aliquots of saline. Six subjects were lavaged with room-temperature saline without receiving supplemental O2, 7 subjects were lavaged with room-temperature saline while receiving supplemental O2 and 6 subjects were lavaged with body-temperature saline while receiving supplemental O2. Six control subjects (3 breathing room air and 3 receiving supplemental O2) underwent a sham lavage. Then, 133Xe ventilation scans (with washouts) and 133Xe perfusion scans were performed at intervals over the next 24 h. Arterial blood gas [Pa] analyses were performed during lavage and at intervals over the next 24 h. Static and dynamic lung volumes, flow rates, airway resistance and single-breath N washout were performed before lavage and 2-4 after lavage. The 6 subjects lavaged while breathing room air, and the 3 control subjects breathing room air developed arterial hypoxemia (PaO2 < 80 mm Hg), and 2 subjects and 1 control subject developed PaO2 values below 60 mm Hg. The use of supplemental O2 reduced but did not eliminate the hypoxemia during lavage. PaO2 was above 80 mm Hg by 1 h after lavage in all subjects lavaged while breathing room air. The subjects lavaged while receiving supplemental O2 had significantly lower values for PaO2 for 8 h after lavage when compared with control subjects, and at 90 and 120 min after lavage compared with subjects lavaged while breathing room air. Ventilation and perfusion scintiphotographs showed that all lavaged subjects developed abnormalities in the lavaged lung at some point after lavage. The abnormalities usually persisted 6-8 h after lavage, and they returned to normal by 24 h in all but 1 subject. The subjects lavaged while breathing room air developed more intense perfusion defects, as shown by scan, than the subjects lavaged with supplemental O2. Subjects lavaged with room-temperature saline developed a 20% reduction in total lung capacity not observed in the control subjects or in the subjects lavaged with body-temperature saline.