Alveolar proteinosis lung lavage using partial cardiopulmonary bypass.

Abstract

An adult case of pulmonary alveolar proteinosis presented with an arterial oxygen tension of 27 mmHg (3-6 kPa) while breathing air. Dangerous hypoxaemia during lung lavage was avoided by using partial cardiopulmonary bypass.

Pulmonary Alveolar Proteinosis in Extremis: The Case for Aggressive Whole Lung Lavage with Extracorporeal Membrane Oxygenation Support

“…[1][2][3][4][5][6][7][8][9] No distinct advantage has yet been proven for either approach. Of particular note, however, is the fact that our regime of lavage was significantly more aggressive than any previously reported.…”

“…To our knowledge, only nine cases of adult PAP patients requiring WLL with ECMO support have previously been reported in the literature. [1][2][3][4][5][6][7][8][9] These are summarised in Table 1. In comparison with the previously reported cases, our patient had considerably more severe respiratory failure prior to lavage.…”

Rare diseases bullet 6: Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis

“…99 Haemodynamic changes occur with single lung ventilation98 100 but invasive monitoring is unnecessary in most cases 101. Hyperbaric oxygen,102 partial cardiopulmonary bypass,103and temporary venovenous extracorporeal gas exchange104 105 have been used as supportive measures for patients with severe hypoxaemia and in children undergoing whole lung lavage.…”

Pulmonary Alveolar Proteinosis

“…151,152 Over the years this original procedure has been refined and modified to achieve good results with less procedural difficulty and fewer complications. 95,126,[153][154][155][156][157][158][159][160][161][162][163][164][165][166][167][168][169][170][171][172] The modifications include routine use of general anesthesia, 153,154 larger lavage volume, 154,155 lobar lavage, 162 positional clearance, 161 and chest percussion. 159,161 Additionally, successful completion of bilateral sequential 126 and simultaneous 163 wholelung lavage in the same session has been achieved.…”