Whole lung lavage in pulmonary alveolar proteinosis: anesthetic management and challenges | ||||
| Ain-Shams Journal of Anesthesiology | ||||
| Volume 14, Issue 1, January 2022 PDF (714.05 K) | ||||
| DOI: 10.1186/s42077-022-00213-6 | ||||
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| Authors | ||||
Manisha Manohar; Priyanka Bansal 
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| Abstract | ||||
| Background Pulmonary alveolar proteinosis is a rare disorder characterized by alveolar obstruction secondary to the collection of lipoproteinaceous material in the alveoli leading to a spectrum of respiratory illness ranging from mild to severe respiratory failure. Whole lung lavage considered the gold standard for the treatment of PAP is performed under general anesthesia and presents a unique set of challenges to the anesthesiologist. The procedure involves manually removing the lipoproteinacious material by repeating aliquots of fluids and draining periodically after percussion. When done effectively it is quite effective and life-saving procedure. Case presentation A 39-year-old female presented with history of gradually progressive shortness of breath, diagnosed to have primary pulmonary alveolar proteinosis for which bilateral whole lung lavage was planned. During the lavage cycles, patient had episodes of desaturation to 60% during which the double lung ventilation was resumed. Her serial ABG revealed a deteriorating oxygenation. In view of increased oxygen requirements, the procedure was carried out in two stages. She made a complete recovery after the procedure. Conclusions A multidisciplinary team working with good communication, use of adequate back up plans, meticulous lung separation with double lumen tube, vigilant intraoperative monitoring, short-term postoperative ventilation go a long way in achieving adequate gas exchange in patients with respiratory failure due to pulmonary alveolar proteinosis. | ||||
| Keywords | ||||
| Pulmonary alveolar proteinosis; Whole lung lavage; Lipoproteinatious | ||||
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