Bronchioalveolar lavage with perfluorochemical liquid during conventional ventilation.
OBJECTIVE
Therapeutic approaches with bronchioalveolar lavage are currently used in infants with severe alveolar space-occupying material. In many circumstances, bronchioalveolar lavage has been performed in conjunction with extracorporeal membrane oxygenation.


METHODS
A 2-month-old boy with severe respiratory failure requiring assisted ventilation did not respond to any conventional treatments, including surfactant. An open-lung biopsy showed intra-alveolar accumulation of proteinaceous material and foamy macrophages but was not diagnostically conclusive. Therapeutic trials with bronchioalveolar lavage using normal saline were unsuccessful, causing episodes of severe hypoxemia. Then, bronchioalveolar lavage during conventional mechanical ventilation was performed with the use of a medical-grade perfluorochemical liquid (perfluordecalin). After instillation of liquid (10 mL/kg), the lungs were refilled three times during the first 24 hrs and repeated 48 hrs later. During perfluorochemical liquid treatment, the infant's condition remained stable, with small improvements in pulmonary mechanics. Suction from the endotracheal cannula yielded only small amounts of gelatinous material. Considering the progression of the disease and just minimal pulmonary improvements by this intervention, further treatment was considered futile. Support was, thus, minimized, and the infant died a few days later. An autopsy revealed the diagnosis to be consistent with Niemann-Pick C2 disease.


CONCLUSIONS
This study demonstrated that bronchioalveolar lavage with perfluorochemical liquid could be performed safely during conventional mechanical ventilation without the additional support of extracorporeal membrane oxygenation in infants with severe alveolar space-occupying material.
Lindemann
Rolf
R
Paediatric Intensive Care Unit, Department of Paediatrics, Ulleval University Hospital, University of Oslo, Oslo, Norway. roli@uus.no
Rajka
Thomas
T
Henrichsen
Thore
T
Vinorum
Ole Georg
OG
de Lange
Charlotte
C
Erichsen
Aage
A
Fugelseth
Drude
D
D018893:Bronchoalveolar Lavage / Q000379:methods*; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D005466:Fluorocarbons / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D021061:Liquid Ventilation; D008297:Male; D052556:Niemann-Pick Disease, Type C / Q000150:complications; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*
D005466:Fluorocarbons; C008805:perfluorodecalin