title: Extracorporeal membrane oxygenation to support repeated whole-lung lavage in a patient with pulmonary alveolar proteinosis in life threatening dyspnoe--a case report.
abstract: BACKGROUND
  Pulmonary alveolar proteinosis is a rare disorder that is characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Clinical symptoms are variable and depend on the severity of damage of the lung parenchyma. Treatment method is whole-lung lavage, where the accumulated lipoproteinaceous material is removed using large quantities of saline.
  
  
  METHODS
  This case report describes a 45 year old patient with advanced pulmonary alveolar proteinosis. Due to the presence of severe global respiratory insufficiency, this patient could not undergo the classic whole-lung lavage using a double-lumen tube and selective lung ventilation. The whole-lung lavage was performed with the support of veno-venous extracorporeal membrane oxygenation. A total of 27 l of warm saline was used.
  
  
  CONCLUSIONS
  According to the current published literature, whole-lung lavage with extra-corporeal membrane oxygenation support is a very rare treatment method. Even when taking into account all of the risks associated with whole-lung lavage and v-v extracorporeal membrane oxygenation support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.
authors.affiliation: Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Charles University in Prague, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. martina.krecmerova@fnmotol.cz.|Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Motol University Hospital, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. martina.krecmerova@fnmotol.cz.
authors.forename: Martina
authors.initials: M
authors.lastname: Krecmerova
authors.affiliation: Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Charles University in Prague, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. frantisek.mosna@fnmotol.cz.|Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Motol University Hospital, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. frantisek.mosna@fnmotol.cz.
authors.forename: Frantisek
authors.initials: F
authors.lastname: Mosna
authors.affiliation: Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Charles University in Prague, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. vladimir.bicek@fnmotol.cz.|Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Motol University Hospital, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. vladimir.bicek@fnmotol.cz.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Bicek
authors.affiliation: Pneumology Department, 2nd Faculty of Medicine, Charles University in Prague, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. frantisek.petrik@fnmotol.cz.
authors.forename: Frantisek
authors.initials: F
authors.lastname: Petrik
authors.affiliation: Pneumology Department, 2nd Faculty of Medicine, Charles University in Prague, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. albeta.grandcourtova@fnmotol.cz.
authors.forename: Alzbeta
authors.initials: A
authors.lastname: Grandcourtova
authors.affiliation: Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University in Prague, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. marek.lekes@fnmotol.cz.
authors.forename: Marek
authors.initials: M
authors.lastname: Lekes
authors.affiliation: Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Charles University in Prague, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. tomas.vymazal@fnmotol.cz.|Department of Anaesthesiology and ICM, 2nd Faculty of Medicine, Motol University Hospital, Prague, V Úvalu 84, 150 06, Praha 5, Czech Republic. tomas.vymazal@fnmotol.cz.
authors.forename: Tomas
authors.initials: T
authors.lastname: Vymazal
mesh_terms: D018893:Bronchoalveolar Lavage / Q000379:methods*; D004417:Dyspnea / Q000209:etiology / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011649:Pulmonary Alveolar Proteinosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome