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LETTER TO THE EDITOR

Bilateral Whole Lung Lavage in the Treatment of Pulmonary Alveolar Proteinosis

Department of Anesthesiology, Perioperative Medicine and Pain (Kumar, Sengupta, Rudra, Maitra) Department of Pulmonary Medicine; Apollo Gleneagles Hospitals; Kolkata, India; dr_palashkumar{at}yahoo.com (Ramasubban, Mukhopadhyay)

To the Editor:

We present a case of pulmonary alveolar proteinosis managed by bilateral whole lung lavage. A 45-year-old woman weighing 56 kg presented with worsening dyspnea and was diagnosed with pulmonary alveolar proteinosis. Her room air oxygen saturation was 78%–83%, and her Pao₂ was 56 mm Hg. Whole lung lavage was recommended to improve her symptoms (1,2). Anesthesia was induced with propofol. Her trachea was intubated with a 35F double-lumen tube, and we verified that the lungs could be isolated. Anesthesia was maintained with propofol (75–100 µg · kg^–1 · min^–1). Muscle relaxation was provided with rocuronium.

The lungs were ventilated using 100% O₂. The lungs were isolated, and the right lung was lavaged with warm isotonic saline until the effluent became clear, while the left lung was ventilated. After lavage, the right lung was suctioned and ventilated until tidal volume returned to baseline. The left lung was then lavaged in the same manner. Her hemodynamics remained stable throughout the procedure. Marked radiologic improvement was evident the next day (Fig. 1), and the room air Pao₂ improved to 77 mm Hg.

View larger version (85K): [in this window] [in a new window]   Figure 1. Radiographs showing marked improvement after bilateral whole lung lavage.

REFERENCES

1. Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med 2003;349:2527–39.[Free Full Text]
2. Shah PL, Hansell D, Lawson PR, et al. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis. Thorax 2000;55:67–77.[Free Full Text]

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