Related Experiment Video
Updated: Jun 5, 2026
Bronchoalveolar Lavage (BAL) for Research; Obtaining Adequate Sample Yield
Published on: March 24, 2014
Whole-lung lavage in infants and children with pulmonary alveolar proteinosis
Karl Reiter1, Carola Schoen, Matthias Griese
1Kinderklinik und Kinderpoliklinik der Universitaet Muenchen am Dr. von Haunerschen Kinderspital, Muenchen, Germany. karl.reiter@med.uni-muenchen.de
Insights
A novel whole-lung lavage (WLL) technique safely adapted for pediatric patients with pulmonary alveolar proteinosis (PAP) shows promise. This modified WLL procedure offers a potential treatment option for children with this rare lung disease.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Critical Care
Background:
- Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by alveolar filling.
- Current treatment involves therapeutic whole-lung lavage (WLL), but adult techniques require modification for pediatric patients due to airway size differences.
Purpose of the Study:
- To describe a modified whole-lung lavage (WLL) technique suitable for treating small children with pulmonary alveolar proteinosis (PAP).
Main Methods:
- A novel WLL technique was developed, incorporating safe single-lung ventilation.
- An age-appropriate endotracheal tube and a balloon catheter for selective main bronchus occlusion were utilized.
- Lavage was performed through the occluded bronchus, with effectiveness assessed by changes in oxygen requirements and adverse events.
Main Results:
- Sixty-four WLL procedures were conducted on four pediatric patients (13 months to 7 years) with PAP.
- Two patients demonstrated reduced oxygen dependency and improved radiological findings post-WLL.
- Two patients did not show significant improvement; transient hypoxemia was the primary adverse effect.
Conclusions:
- The described WLL technique, combining single-lung ventilation and balloon catheter-guided lung exclusion, can be safely and effectively applied to pediatric patients with PAP.
- This adapted WLL method provides a viable treatment strategy for infants and young children suffering from this rare alveolar filling syndrome.
Background:
Pulmonary alveolar proteinosis (PAP) is a rare alveolar filling syndrome where the mainstay of treatment is therapeutic whole-lung lavage (WLL). WLL techniques used in adults have to be modified for children because of their small-diameter airways.
Aim:
To describe a technique for WLL adapted for small children.
Methods:
We describe a WLL technique that combines safe single-lung ventilation with the use of an age-appropriate endotracheal tube and selective occlusion of the other main bronchus with a balloon catheter through which the lavage is performed. Effectiveness measured by change in oxygen requirements and adverse effects was noted.
Results:
We performed 64 WLL procedures in four children (age 13 months to 7 years; body weight 4.7-14 kg). Two children had idiopathic and two had secondary PAP. At referral, all children had dyspnoea at rest and required continuous oxygen supplementation. Two patients showed significantly decreased oxygen demands and radiological improvement after WLL. Two patients showed no significant response. The only adverse effect observed was transient hypoxemia. Complications comprised fluid leak at the balloon (4), balloon rupture (1), and pneumothorax (1).
Conclusions:
This technique for WLL combining single-lung ventilation with an endotracheal tube and lung exclusion for lavage with a balloon catheter can be safely and effectively performed in small children with PAP.
