Light chain deposition disease (LCDD) is a rare condition characterized by extracellular light chain deposition in tissues. Patients commonly have an underlying plasma cell dyscrasia, and produce excess levels of monoclonal light chains. Renal involvement is the most common clinical manifestation. Rarely, light chains are deposited in the lung. We present the pathologic and radiographic findings of three patients with biopsy-proven pulmonary light chain disease and a review of the literature.

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Prolonged mechanical ventilation (MV) is a hallmark of chronic critical illness (CCI) and a major source of distress for patients, who struggle to communicate even after tracheotomy. In this pilot study, we evaluated the use of a Passy−Muir (PM) speaking valve to assist communication by CCI patients during weaning from the ventilator. Methods: We studied consecutive, consenting, ventilator −dependent, tracheotomized patients admitted from adult ICUs to our Respiratory Care Unit (RCU) for protocol−based weaning. Participation required ability to respond to English−language evaluative tools, tolerance of cuff deflation, no vocal cord dysfunction, and expected RCU stay ³10 days. The PM valve was placed for up to 60 minutes, as tolerated. Before and after valve placement, research staff recorded physiologic parameters (blood pressure, pulse, respiratory rate, SaO2), and patients rated communication (none to maximum ability) and dyspnea (none to maximum shortness of breath) on 0−10 scales. Results: We enrolled 10 of 13 (77%) eligible patients (5 men; mean±SD age = 68±17.1 yrs; MV duration = 22.4±11.2 days). The 60−minute trial was completed by 5 patients without subjective or objective distress. PM valve removal was requested by 5 patients at a median of 2 minutes (range 1−30) after placement due to dyspnea. Staff noted accessory muscle use in 3 of these 5, but none had any physiologic deterioration. Mean communication ratings improved from 3.7±3.8 to 6.7± 3.2 with valve use. Patients who tolerated the 60−minute trial reported better communication and less dyspnea than those who did not (communication, 10±0 vs. 4.4±2.2; dyspnea, 4.3±2.9 vs. 6.6±3.9). Conclusions: The PM speaking valve is tolerated by some CCI patients and may facilitate communication as perceived by patients and caregivers during weaning from MV. In a larger sample, factors predicting tolerance and effectiveness of the valve in enabling communication may be identified.