title: Alveolar proteinosis in extremis: a critical case treated with whole lung lavage without extracorporeal membrane oxygenation.
abstract: Pulmonary alveolar proteinosis is a rare idiopathic lung disease characterized by the accumulation of lipoproteinaceous material within the alveoli, which impairs gas transfer and decreases the ventilation/perfusion ratio, and can lead to respiratory failure. Whole lung lavage is the most effective therapy for pulmonary alveolar proteinosis, but may not be tolerated by patients with severe respiratory failure. Extracorporeal membrane oxygenation support is advocated for such patients to ensure appropriate oxygenation during lung lavage. We report a case of a 39-year-old patient with pulmonary alveolar proteinosis and severe life-threatening respiratory failure, with an oxygen index of 51 when under mechanical ventilation. The patient was successfully treated with bilateral whole lung lavage without extracorporeal oxygenation. The results suggest that there is improved ventilation and perfusion matching when one lung is ventilated while the other is lavaged, may be the mechanism of which severe respiratory failure patient due to pulmonary alveolar proteinosis can complete whole lung lavage under one lung ventilation.
authors.affiliation: Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University Guangzhou, China.
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Guo
authors.affiliation: Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University Guangzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University Guangzhou, China.
authors.forename: Nan-Shan
authors.initials: NS
authors.lastname: Zhong
authors.affiliation: Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University Guangzhou, China.
authors.forename: Zhu-Quan
authors.initials: ZQ
authors.lastname: Su
authors.affiliation: Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University Guangzhou, China.
authors.forename: Chang-Hao
authors.initials: CH
authors.lastname: Zhong
authors.affiliation: Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University Guangzhou, China.
authors.forename: Shi-Yue
authors.initials: SY
authors.lastname: Li
keywords: Pulmonary alveolar proteinosis; extracorporeal membrane oxygenation; severe respiratory failure; treatment; ventilation/perfusion; whole lung lavage