How We Do It: Whole Lung Lavage.

Area of Science:

• Pulmonology
• Critical Care Medicine

Background:

• Pulmonary alveolar proteinosis (PAP) is a rare lung disease causing surfactant accumulation and hypoxemic respiratory failure.
• Whole lung lavage (WLL) is the primary treatment, physically removing lipoproteinaceous material from alveoli.
• Despite its use since 1963, WLL lacks standardized protocols.

Purpose of the Study:

• To provide a detailed, step-by-step description of the Whole Lung Lavage (WLL) procedure for Pulmonary Alveolar Proteinosis (PAP).
• To outline essential precautions and monitoring strategies during WLL.
• To offer visual aids, including videos, demonstrating key aspects of the procedure.

Main Methods:

• WLL performed under general anesthesia with a double lumen endotracheal tube for one-lung ventilation.
• Lavage of one lung using liter aliquots of pre-warmed saline.
• Gravity-assisted drainage after each cycle until lavage fluid clears (typically 15-20 cycles).

Main Results:

• Successful physical removal of surfactant and lipoproteinaceous material from the alveolar spaces.
• Demonstration of effective one-lung ventilation and lung isolation techniques.
• Clearance of lavage fluid indicating procedure completion.

Conclusions:

• The described WLL procedure provides a standardized approach to managing PAP.
• Careful execution and monitoring are crucial for patient safety and treatment efficacy.
• This detailed guide and accompanying videos can aid clinicians in performing WLL.