Bronchopulmonary lavage for pulmonary alveolar proteinosis

In summary, total-lung bronchopulmonary lavage was performed five times on two patients under general anesthesia with controlled ventilation using a Robert-Shaw double lumen ETT. One lavage was complicated by a hydrothorax that was treated without untoward sequelae. No significant hypoxemia, circulatory impairment or leakage of lavaged fluid into the opposite lung was noted on any occasion. The average time of all procedures was 108 minutes (range 80-150 minutes), and patients were extubated on all occasions 2 to 5 hours after the treatment. Patients were discharged 24 to 36 hours after the last lavage with improvement, though not resolution, of the alveolar infiltrates radiographically. The ABG analysis revealed minimal improvement in oxygenation in Case No.1 from a preoperative paO2 of 60 mmHg on room air to a paO2 of 74 mmHg on the day of discharge. However, the patient was able to resume his normal activity level. In Case No.2, the patient's resting paO2 did not improve significantly from the preoperative value of 82 mmHg. Subjectively, however, the patient noted marked improvement. Prior to bronchopulmonary lavage, this patient's SaO2 decreased from 97% to 81% after walking 800 feet. Approximately a week and a half after discharge, the patient reported being able to run without symptoms and generally was feeling well. With careful attention to detail and the coordination of resources from the departments of anesthesia, pulmonary medicine, respiratory therapy and nursing services, bronchopulmonary lavage can be performed safely and efficiently in order to curtail the progressive hypoxemia which often develops in patients with PAP.