Whole-lung lavage

Abstract

Pulmonary alveolar proteinosis (PAP) is a disease characterized by the accumulation ofamorphous lipoproteinaceous material in the alveoli. Whole-lung lavage (WLL) is the first lineof treatment for patients symptomatic from PAP. The procedure involves intubating the patient with a double-lumen endotracheal tube to isolate the two lungs, ventilating one lung while performing a large-volume lavage (up to 20 L) of the other lung with warmed normal saline. Aliquotsof1 L on saline are instilled into the lung, chest percussion is performed, and the proteinaceouseffluent is drained by gravity. The procedure is repeated for the contralateral lung. The process physically removes the amorphous material from the alveoli and improves oxygenation. Intraoperative refractory hypoxia is the most common complication of the procedure but tends to be self-limited and transient. If required by the severity of hypoxia, extracorporeal membrane oxygenation (ECMO) may be utilized to complete the procedure. There is a significant improvement, both clinically and radiologically, following the procedure. Some patients may require the procedure repeatedly during the course of the disease.