Impact of Saline Instillation and Drainage on Oxygenation During Whole Lung Lavage

Whole lung lavage (WLL) for pulmonary alveolar proteinosis, performed under one-lung ventilation (OLV), illustrates the dynamic interplay between alveolar expansion and pulmonary vascular responses. Instillation of warm saline into the nonventilated lung compresses pulmonary vessels, mimicking hypoxic pulmonary vasoconstriction and enhancing oxygenation. Conversely, drainage of the saline relieves vascular compression, worsens ventilation-perfusion (V/Q) mismatch, and leads to a decline in oxygenation. This cyclical pattern underscores the physiological shifts that influence oxygenation during WLL.