title: A 3-step therapeutic strategy for severe alveolar proteinosis.
abstract: Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of lipoproteinaceous material in the terminal airways. Whole lung lavage (WLL) remains the gold standard treatment but may be particularly challenging in cases of severe hypoxemia. We present a 3-step strategy that was used in a patient with PAP-associated refractory hypoxemia and that combined venovenous extracorporeal membrane oxygenation (vvECMO), double-lumen orotracheal intubation, and bilateral multisegmental sequential lavage (MSL). The procedure was well tolerated and permitted weaning from the ventilator.
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Leslie
authors.initials: L
authors.lastname: Noirez
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Angela
authors.initials: A
authors.lastname: Koutsokera
authors.affiliation: Department of Intensive Care Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Pantet
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: François-Régis
authors.initials: FR
authors.lastname: Duss
authors.affiliation: Department of Intensive Care Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.affiliation: Department of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: Department of Intensive Care Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Marcos
authors.initials: M
authors.lastname: Coronado
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Laurent P
authors.initials: LP
authors.lastname: Nicod
authors.affiliation: Department of Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland. Electronic address: alban.lovis@chuv.ch.
authors.forename: Alban
authors.initials: A
authors.lastname: Lovis
mesh_terms: D000328:Adult; D018893:Bronchoalveolar Lavage / Q000379:methods*; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000628:therapy; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D011649:Pulmonary Alveolar Proteinosis / Q000000981:diagnostic imaging / Q000628:therapy*; D013902:Radiography, Thoracic / Q000379:methods; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D016896:Treatment Outcome