title: Pulmonary alveolar proteinosis: step-by-step perioperative care of whole lung lavage procedure.
abstract: BACKGROUND
  Pulmonary alveolar proteinosis is a rare disease characterized by the accumulation of surfactant-like material within the alveolar spaces that causes progressive respiratory failure. Improvement can be achieved with whole lung lavage.
  
  
  OBJECTIVE
  Our objective was to conduct a study of the feasibility of treating pulmonary alveolar proteinosis in a community hospital.
  
  
  METHODS
  Five patients were treated. We assessed procedure pulmonary functions.
  
  
  RESULTS
  No major sequelae occurred. Each lung was lavaged with 12 to 20 L of normal saline in cycles of 970 +/- 150 mL each (mean +/- standard deviation), over 106 +/- 49 minutes. Extubation was performed when compliance of the lavaged lung was restored. All patients showed subjective improvement. Resting and exercise oxygen saturation improved within 1 week after the lavage. A significant improvement was also noted in forced expiratory volume in 1 second, forced vital capacity, and maximal oxygen uptake, whereas total lung capacity and carbon monoxide single-breath diffusion capacity remained unchanged.
  
  
  CONCLUSIONS
  Although retrospective and based on a small sample size, our results suggest that whole lung lavage may be performed safely even in medical centers that have limited experience, if strict adherence to a protocol is maintained.
authors.affiliation: Department of Anesthesiology and Critical Care, Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Ben-Abraham
authors.forename: Adrian
authors.initials: A
authors.lastname: Greenfeld
authors.forename: Judith
authors.initials: J
authors.lastname: Rozenman
authors.forename: Issahar
authors.initials: I
authors.lastname: Ben-Dov
mesh_terms: D000328:Adult; D018893:Bronchoalveolar Lavage / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011649:Pulmonary Alveolar Proteinosis / Q000628:therapy*; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome