How we do it: whole lung lavage : Whole lung lavage

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

doi:10.36141/svdld.v39i2.12884

How we do it: whole lung lavage

Whole lung lavage

Authors

Deepa Shreshta Postgraduate Institute of Medical Education and Research
Sahajal Dhooria Postgraduate Institute of Medical Education and Research
Ganesh Kumar Munirathinam Postgraduate Institute of Medical Education and Research
Inderpaul Singh Sehgal Postgraduate Institute of Medical Education and Research
Kuruswamy Thurai Prasad Postgraduate Institute of Medical Education and Research
Babu Ram Postgraduate Institute of Medical Education and Research
Harkant Singh Postgraduate Institute of Medical Education and Research
Ashutosh Nath Aggarwal Postgraduate Institute of Medical Education and Research
Goverdhan D Puri Postgraduate Institute of Medical Education and Research
Valliappan Muthu a:1:{s:5:"en_US";s:56:"Postgraduate Institute of Medical Education and Research";}
Ritesh Agarwal Postgraduate Institute of Medical Education and Research

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

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