title: [Pulmonary alveolar proteinosis treated with whole-lung lavage utilizing extracorporeal membrane oxygenation: a case report and review].
abstract: OBJECTIVE
  To improve the treatment of severe hypoxaemia in patients with pulmonary alveolar proteinosis (PAP).
  
  
  METHODS
  The clinical data of a patient with pathologically proven PAP treated with whole-lung lavage utilizing extracorporeal membrane oxygenation (ECMO) were described and the literature was reviewed.
  
  
  RESULTS
  This 57-year-old man was admitted because of cough and progressive dyspnea for 12 months. His PaO(2) was 46 mm Hg (1 mm Hg = 0.133 kPa) and saturation of pulse oximeter (SpO(2)) was from 85% to 88% with oxygen 5 L/min by nasal cannula. His chest CT, bronchoscopy with bronchoalveolar lavage and transbronchial biopsies were consistent with PAP. Whole-lung lavage was performed in the operation room under general anesthesia. A double-lumen tube was intubated in order to selectively ventilate and lavage a single lung independently. During mechanical ventilation for both lungs, the SpO(2) was from 80% to 90%, but when a single right lung ventilation was tried, the SpO(2) (from 68% to 80%) dropped significantly. To ensure adequate oxygen supply during lavage, a veno-arterial ECMO was set up by inserting catheters percutaneously into the right femoral artery and right femoral vein respectively. Then the SpO(2) improved, from 89% to 97% during single right lung ventilation. The left lung was lavaged with a total of 20.8 L of normal saline. The SpO(2) ranged from 80% to 94% during the lavage. After the lavage, the patient no longer experienced shortness of breath. Then 28 days later the right lung was lavaged without the aid of ECMO. A month after the second lavage, his chest CT showed marked improvement in infiltrates of both lungs.
  
  
  CONCLUSIONS
  When a patient with PAP has refractory hypoxemia prior to the lavage procedure, ECMO should be considered in order to avoid severe hypoxaemia with fatal consequences during lavage.
authors.affiliation: Department of Respiratory Medicine, Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Hou-rong
authors.initials: HR
authors.lastname: Cai
authors.forename: Su-yang
authors.initials: SY
authors.lastname: Cui
authors.forename: Ling
authors.initials: L
authors.lastname: Jin
authors.forename: Yi-zhen
authors.initials: YZ
authors.lastname: Huang
authors.forename: Bin
authors.initials: B
authors.lastname: Cao
authors.forename: Zhe-yan
authors.initials: ZY
authors.lastname: Wang
authors.forename: Guo-hua
authors.initials: GH
authors.lastname: Mu
authors.forename: Xian-mei
authors.initials: XM
authors.lastname: Zhou
mesh_terms: D018893:Bronchoalveolar Lavage / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011649:Pulmonary Alveolar Proteinosis / Q000628:therapy*