ABSTRACT
Pulmonary alveolar proteinosis is a rare disease of unknown etiology characterized by the accumulation of phospholipids and proteinaceous material in the alveolar spaces. Sequential bronchopulmonary lavage with 2-4 days interval has been the most acceptable method of treatment. Prognosis after bronchopulmonary lavage is very variable. We have experienced recurred case of pulmonary alveolar proteinosis. In this case we have performed sequential lavage in one stage safely. Complete removal of lavage fluid, facilitation of oxygenation by ventilation of lavaged lung with positive end expiratory pressure, and adequate evaluation of oxygenation enabled sequential lavage in one stage. We report a case of sequential bronchopulmonary lavage in one stage in a patient with a recurred pulmonary alveolar proteinosis.
Subject(s)
Humans , Bronchoalveolar Lavage , Lung , Oxygen , Phospholipids , Positive-Pressure Respiration , Prognosis , Pulmonary Alveolar Proteinosis , Rare Diseases , Therapeutic Irrigation , VentilationABSTRACT
Bronchopulmonary lavage using a double-lumen endotracheal tube is an accepted modality for treatment of pulmonary alveolar proteinosis which characterized by filling of alveolar space with periodic acid-schiff positive proteinaceous material. Massive bronchopulmonary lavage is not without hazard. Improper positioning and inadequate cuff inflation of the endotracheal tube may lead drowning. So correct placement of double-lumen endotracheal tube and confirming complete seperation of the two lungs is important to prevent drowning. And periods of tidal drainage are accompanied with reperfusion to the non-ventilated lung and cause potentially dangerous levels of hypoxemia. One must investigate maneuvers to minimize perfusion to non-ventilated lung and to maximize gas exchange during unilateral lung lavage. The distribution of pulmonary blood flow during unilateral lung lavage can be manipulated by nonocclusive inflation of an ipsilateral pulmonary artery balloon. We report a case of sequential bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis performed safely with pulmonary arterial catherter insertion.