Outpatient lobar lavage: a novel approach to managing pulmonary alveolar proteinosis
Bibliographic record
Abstract
Background: Pulmonary alveolar proteinosis (PAP) is a characterized by impaired surfactant production or processing leading to an accumulation of periodic acid-Schiff lipoproteinaceous material in the alveoli. The mainstay of treatment is whole lung lavage requiring intubation and general anaesthesia. We present a 31 year-old female with PAP previously treated with whole lung lavage who had increasing dyspnea and cough, but without resting hypoxia. She had progressive crazy paving on imaging and restriction with reduced diffusion on pulmonary function testing. Objective: We aimed to treat a case of moderate PAP with outpatient lobar lavages. Methods: Flexible bronchoscopy was performed with conscious sedation every 2 weeks. One lobe was treated at each session, with the exception of the right middle and upper lobes which were targeted during the same procedure. The most involved lobes were treated first. During each procedure a total of 2 litres of warmed saline was instilled via a flushing pump (Olympus OFP-2) in aliquots of 100mls through the working channel and suctioned. Results: A total of four outpatient bronchoscopies were completed. Over 90% of the instilled saline was suctioned at each procedure. Other than transient desaturations which were managed with jet ventilation via the bronchoscope, no other complications occurred and the patient was discharged home on the same day of each procedure. At 2 months follow-up she had improvements in her symptoms, imaging findings, and diffusing capacity. Conclusions: We describe the successful application of a novel approach to treating PAP on an outpatient basis, preventing the need for intubation and general anaesthesia.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".