Pulmonary alveolar proteinosis: step-by-step perioperative care of whole lung lavage procedure.
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.
Ben-Abraham
Ron
R
Department of Anesthesiology and Critical Care, Faculty of Medicine, Tel Aviv University, Israel.
Greenfeld
Adrian
A
Rozenman
Judith
J
Ben-Dov
Issahar
I
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