[Alveolar proteinosis--therapy concept with a modified BAL]

Area of Science:

• Pulmonology
• Respiratory Medicine

Background:

• Alveolar proteinosis is a rare lung disease characterized by surfactant accumulation.
• Therapeutic lung lavage is a standard treatment, typically involving large fluid volumes (up to 50 liters).

Observation:

• Two male patients (48 and 35 years old) with primary alveolar proteinosis underwent a modified lavage procedure.
• The modified technique, termed "ambu-lavage," involves filling one lung with 1 liter of warm saline, mixing with an ambu-bellows for three minutes, and removing the fluid, followed by smaller cycles up to 5 liters per lung.
• Each lung was lavaged 2-3 times, with protein concentration monitored in each lavage portion.

Findings:

• Both patients tolerated the ambu-lavage procedure well under anesthesia with a double-lumen tube, experiencing no complications.
• Significant improvements were observed in pulmonary function tests and blood-gas analysis.
• Patient dyspnea resolved post-procedure.

Implications:

• The ambu-lavage technique presents a potentially faster and effective alternative for treating alveolar proteinosis.
• This modified approach may improve patient outcomes and reduce procedure time compared to standard lung lavage.
• Further investigation into the ambu-lavage technique for alveolar proteinosis is warranted.