The use of a membrane oxygenator with extracorporeal circulation in bronchoalveolar lavage for alveolar proteinosis.
Alveolar proteinosis is a rare pulmonary disease, characterised by the accumulation of a proteinaceous material in the alveoli, which severely reduces gas exchange and causes progressive disability of the patient, usually moderate, but sometimes completely disabling. Whole-lung lavage (WLL) is the preferred technique for the treatment of this disease, and it is performed by introducing into the lungs and draining a fluid (saline), which removes the phospholipidic material present in the alveoli, offering the patient a marked improvement in a short period of time. Sometimes the whole-lung lavage technique is not well tolerated by the patient, requiring the support of a membrane oxygenator during the course of the procedure. Few successful cases have been published. We report the case of a 33-year-old man with severe hypoxaemia who suffered cardiopulmonary arrest after the first attempt of bronchoalveolar lavage (BAL) and required support by means of extracorporeal venovenous circulation with a membrane oxygenator (ECMO). An initial incomplete lavage was performed with ECMO support, but the patient was re-admitted 7 months later and we performed a second WLL of both lungs in the same session, again using ECMO. Also, the BAL technique and its association with ECMO when necessary are reviewed.
Department of Cardiovascular Surgery Service, Ramón y Cajal Hospital, Madrid, Spain. centellato@teleline.es
Tomasa
T
Centella
Enrique
E
Oliva
Ignacio G
IG
Andrade
Antonio
A
Epeldegui