Pulmonary alveolar proteinosis: Step-by-step perioperative care of whole lung lavage procedure

BACKGROUND: Pulmonary alveolar proteinosis is a rare disease characterized by the accumulation of surfactant-like material within the alveolar spaces that causes progressive respiratory failure. Improvement can be achieved with whole lung lavage. OBJECTIVE: Our objective was to conduct a study of the feasibility of treating pulmonary alveolar proteinosis in a community hospital. METHODS: Five patients were treated. We assessed procedure and pulmonary functions. RESULTS: No major sequelae occurred. Each lung was lavaged with 12 to 20 L of normal saline in cycles of 970 ± 150 mL each (mean ± standard deviation), over 106 ± 49 minutes. Extubation was performed when compliance of the lavaged lung was restored. All patients showed subjective improvement. Resting and exercise oxygen saturation improved within 1 week after the lavage. A significant improvement was also noted in forced expiratory volume in 1 second, forced vital capacity, and maximal oxygen uptake, whereas total lung capacity and carbon monoxide single-breath diffusion capacity remained unchanged. CONCLUSION: Although retrospective and based on a small sample size, our results suggest that whole lung lavage may be performed safely even in medical centers that have limited experience, if strict adherence to a protocol is maintained.