title: Extracorporeal membrane oxygenation to support whole-lung lavage in pulmonary alveolar proteinosis: salvage of the drowned lungs.
abstract: Pulmonary alveolar proteinosis is a rare lung disease characterized by accumulation of lipoproteinaceous material within the alveoli. Therapeutic whole-lung lavage (WLL) under general anesthesia is the standard treatment in patients with progressive symptomatic disease. Severe hypoxemic respiratory failure is uncommon, yet when present poses a technical challenge to performing WLL without further compromising respiratory status. Rarely, hyperbaric chamber or extracorporeal membrane oxygenation (ECMO) has been utilized to perform WLL to manage severe hypoxemia, with venovenous ECMO being used more often. We present a case of hypoxemic and hypercarbic respiratory failure from pulmonary alveolar proteinosis successfully managed by placing the patient on venoarterial ECMO to facilitate the performance of bilateral WLL.
authors: Department of Pulmonary/Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors: Naveed
authors: N
authors: Hasan
authors: Sidharth
authors: S
authors: Bagga
authors: Julie
authors: J
authors: Monteagudo
authors: Hitoshi
authors: H
authors: Hirose
authors: Nicholas C
authors: NC
authors: Cavarocchi
authors: Boyd T
authors: BT
authors: Hehn
authors: Mani S
authors: MS
authors: Kavuru
mesh_terms: D000328:Adult; D001528:Behcet Syndrome / Q000150:complications / Q000628:therapy; D018893:Bronchoalveolar Lavage / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000628:therapy*; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D011649:Pulmonary Alveolar Proteinosis / Q000150:complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000628:therapy*; D016896:Treatment Outcome