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

BACKGROUND/PATIENTS: This report is about two patients (male, 48 and 35 years old) with a primary alveolar proteinosis where the indication for therapeutic lavage was given. The standard is lavage with up to 50 litres fluid.

We preferred a modified therapy with the so called "ambu-lavage". With this kind of Lavage, first described by Kronenberger et al., one lung is filled with one litre warm (37 degrees C) NaCl-fluid. Then this fluid is mixed up with an ambu-bellows for three minutes and then the fluid is removed of the lung. More cycles with 500 ml fluid follow until the lung is lavaged with five litres. In summary every lung was lavaged two to three times. The protein concentration was checked in every lavage portion.

Both patients tolerated these procedures well, in anaesthesia with a double-lumen-tube. There were no complications. The pulmonary function test and blood-gas-analysis could be improved significantly. Dyspnoea disappeared.

This case-report shows two cases of alveolar-proteinosis which were treated well with the "ambu-lavage" which takes less time than the standard-lavage.