How we do it: whole lung lavage Whole lung lavage

Main Article Content

Deepa Shreshta
Sahajal Dhooria
Ganesh Kumar Munirathinam
Inderpaul Singh Sehgal
Kuruswamy Thurai Prasad
Babu Ram
Harkant Singh
Ashutosh Nath Aggarwal
Goverdhan D Puri
Valliappan Muthu
Ritesh Agarwal

Keywords

: Pulmonary alveolar proteinosis, bronchoscopy, bronchoalveolar lavage, diffuse parenchymal lung disease, interstitial lung disease

Abstract

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by the accumulation of surfactant in the alveolar spaces resulting in hypoxemic respiratory failure. Whole lung lavage (WLL), the preferred treatment for PAP, physically removes the lipo-proteinaceous material from the alveolar spaces. Since its initial description in 1963, the WLL procedure has undergone various modifications. However, the procedure has not been standardized yet. After securing a double lumen endotracheal tube, we perform WLL under general anesthesia. One lung is ventilated, while the other is lavaged using one-liter aliquots of pre-warmed saline. We use gravity-assisted drainage of the lavaged lung after each cycle till the milky white and opaque fluid becomes clear (usually 15-20 cycles). Herein, we describe the step-by-step procedure, precautions, and monitoring of WLL. We also provide videos demonstrating one-lung ventilation and bronchoscopic confirmation of lung isolation.


Keywords: Pulmonary alveolar proteinosis; bronchoscopy; bronchoalveolar lavage; interstitial lung disease: diffuse parenchymal lung disease

Downloads

Download data is not yet available.
Abstract 176 | Video 1 Downloads 0 Video 2 Downloads 0 PDF Downloads 108

References

1. Khan A, Agarwal R. Pulmonary alveolar proteinosis. Respir Care. 2011;56(7):1016-28.
2. Rosen SH, Castleman B, Liebow AA. Pulmonary alveolar proteinosis. The New England journal of medicine. 1958;258(23):1123-42.
3. Ramirez J, Schultz RB, Dutton RE. Pulmonary Alveolar Proteinosis: A New Technique and Rationale for Treatment. Archives of internal medicine. 1963;112:419-31.
4. Ramirez J, Kieffer RF, Jr., Ball WC, Jr. Bronchopulmonary lavage in man. Ann Intern Med. 1965;63(5):819-28.
5. Shah PL, Hansell D, Lawson PR, Reid KB, Morgan C. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis. Thorax. 2000;55(1):67-77.
6. Campo I, Luisetti M, Griese M, Trapnell BC, Bonella F, Grutters J, et al. Whole lung lavage therapy for pulmonary alveolar proteinosis: a global survey of current practices and procedures. Orphanet J Rare Dis. 2016;11(1):115.
7. Michaud G, Reddy C, Ernst A. Whole-lung lavage for pulmonary alveolar proteinosis. Chest. 2009;136(6):1678-81.
8. Khan A, Agarwal R, Aggarwal AN. Effectiveness of granulocyte-macrophage colony-stimulating factor therapy in autoimmune pulmonary alveolar proteinosis: a meta-analysis of observational studies. Chest. 2012;141(5):1273-83.
9. Trapnell BC, Inoue Y, Bonella F, Morgan C, Jouneau S, Bendstrup E, et al. Inhaled Molgramostim Therapy in Autoimmune Pulmonary Alveolar Proteinosis. N Engl J Med. 2020;383(17):1635-44.
10. Radpay B, Parsa T, Dabir S, Boloursaz M, Arbab A, Tabatabaei S. Whole Lung Lavage of Nine Children with Pulmonary Alveolar Proteinosis: Experience in a Tertiary Lung Center. Iranian Journal of Pediatrics. 2013;23(1):95-9.
11. Vymazal T, Krecmerova M. Respiratory Strategies and Airway Management in Patients with Pulmonary Alveolar Proteinosis: A Review. BioMed Research International.2015:1-5.
12. Ramachandran P, Chaudhury A, Devaraj U, Maheshwari K, D'Souza G. Monitoring whole-lung lavage using lung ultrasound: The changing phases of the lung. Lung India. 2018;35(4):350-3.
13. Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis: progress in the first 44 years. Am J Respir Crit Care Med. 2002;166(2):215-35.

Most read articles by the same author(s)