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Published on: March 24, 2014
Bilateral whole lung lavage by lung isolation in a child with pulmonary alveolar proteinosis: A new technique
Brajesh Kaushal1, Sandeeps Chauhan1, Suruchi Hasija1
1Department of Cardiac Anaesthesia, Cardiothoracic Centre, AIIMS, New Delhi, India.
Insights
Two children with rare pulmonary alveolar proteinosis experienced improved breathing and function after a single-sitting whole lung lavage (WLL) procedure. This innovative technique offers a potential salvage therapy for pediatric patients with this challenging lung condition.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Rare Diseases
Background:
- Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by surfactant accumulation in alveoli.
- Pediatric PAP presents with progressive exertional dyspnea, cough, and cyanosis, significantly impacting quality of life.
- High-resolution computed tomography (HRCT) and bronchoalveolar lavage (BAL) are key diagnostic tools for PAP.
Observation:
- Two pediatric patients presented with exertional breathlessness, dry cough, and peripheral cyanosis.
- Diagnosis of PAP was confirmed via HRCT and BAL findings.
- Both patients underwent bilateral whole lung lavage (WLL) as a life-saving intervention.
Findings:
- Bilateral WLL was successfully performed in a single anesthetic session using a modified endotracheal tube.
- The modified anesthetic technique facilitated the challenging WLL procedure in pediatric patients.
- Both children demonstrated significant clinical and functional improvement post-WLL.
Implications:
- Bilateral WLL in a single sitting is a viable and effective salvage therapy for pediatric pulmonary alveolar proteinosis.
- The modified anesthetic approach using a specialized endotracheal tube enhances the safety and feasibility of WLL.
- These rare case reports highlight a crucial treatment option for severe pediatric PAP, improving patient outcomes.
Abstract:
We present two rare cases of children who presented with progressive exertional breathlessness and dry cough. They also had history of bluish discoloration of mucous membranes, hands and feet on exertion. Both were diagnosed to have pulmonary alveolar proteinosis after a high-resolution computed tomography and bronchoalveolar lavage. They were subjected to bilateral whole lung lavage (WLL) as a salvage therapy. Bilateral WLL was performed in a single sitting with the help of a modified endotracheal tube. The anesthetic technique included a modified cuffed endotracheal tube for accomplishing WLL. After the procedure, both children improved clinically and functionally.
