title: Bronchioalveolar lavage with perfluorochemical liquid during conventional ventilation.
abstract: 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.
authors: Paediatric Intensive Care Unit, Department of Paediatrics, Ulleval University Hospital, University of Oslo, Oslo, Norway. roli@uus.no
authors: Rolf
authors: R
authors: Lindemann
authors: Thomas
authors: T
authors: Rajka
authors: Thore
authors: T
authors: Henrichsen
authors: Ole Georg
authors: OG
authors: Vinorum
authors: Charlotte
authors: C
authors: de Lange
authors: Aage
authors: A
authors: Erichsen
authors: Drude
authors: D
authors: Fugelseth
mesh_terms: 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*
chemical_list: D005466:Fluorocarbons; C008805:perfluorodecalin