Pulmonary alveolar proteinosis: repeated bilateral whole lung lavage supported by extracorporeal membrane oxygenation
Abstract
Whole lung lavage with large quantity of normal saline is the current standard of care treatment of pulmonary alveolar proteinosis. This rare disease characterized by alveolar accumulation of lipoproteinaceous material leads to respiratory failure of different severity.
In some cases, it is not possible to perform the treatment safely without risk of severe periprocedural hypoxia. These rare cases can be treated with the support of extracorporeal membrane oxygenation.
We present a case of a 41-year old patient successfully treated with repeated bilateral whole lung lavage supported by extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation has been used during whole lung lavage in patients with risk of life-threatening hypoxia.
The increasing availability and safety of extracorporeal life support methods enables more frequent use of the methods in cases with significant risk of hypoxia related complications that have so far been treated with one lung ventilation. This practice increases not only safety but also effectivity of the procedure because it enables performance of bilateral lavage in one session.