Abstract
Pulmonary alveolar proteinosis (PAP) is a disease characterized by the accumulation of amorphous lipoproteinaceous material in the alveoli. Whole-lung lavage (WLL) is the first line of treatment for patients symptomatic from PAP. The procedure involves intubating the patient with a double-lumen endotracheal tube to isolate the two lungs, ventilating one lung while performing a large-volume lavage (up to 20 L) of the other lung with warmed normal saline. Aliquots of 1 L on saline are instilled into the lung, chest percussion is performed, and the proteinaceous effluent is drained by gravity. The procedure is repeated for the contralateral lung. The process physically removes the amorphous material from the alveoli and improves oxygenation. Intraoperative refractory hypoxia is the most common complication of the procedure but tends to be self-limited and transient. If required by the severity of hypoxia, extracorporeal membrane oxygenation (ECMO) may be utilized to complete the procedure. There is a significant improvement, both clinically and radiologically, following the procedure. Some patients may require the procedure repeatedly during the course of the disease.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Michaud G, Reddy C, Ernst A. Whole lung lavage for pulmonary alveolar proteinosis. Chest. 2009;136:1678–81.
Ramirez JR, Kieffer RF, Ball WC. Bronchopulmonary lavage in man. Ann Intern Med. 1965;63:819–28.
Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis progress in the first 44 years. Am J Respir Crit Care Med. 2002;166:215–35.
Beccaria M, Luisetti M, Rodi G, et al. Long-term durable benefit after whole lung lavage in pulmonary alveolar proteinosis. Eur Respir J. 2004;23:526.
Hammon WE, McCaffree DR, Cucchiara AJ. A comparison of manual to mechanical chest percussion for clearance of alveolar material in patients with pulmonary alveolar proteinosis (phospholipidosis). Chest. 1993;103:1409.
Ramirez J. Pulmonary alveolar proteinosis: treatment by massive bronchopulmonary lavage. Arch Intern Med. 1967;119:147–56.
Rogers RM, Levin DC, Gray BA, et al. Physiologic effects of bronchopulmonary lavage in alveolar proteinosis. Am Rev Respir Dis. 1978;118:255–64.
Rogers RM, Szidon JP, Shelburne J, et al. Hemodynamic response of the pulmonary circulation to bronchopulmonary lavage in man. N Engl J Med. 1972;286:1230–3.
Ben-Abraham R, Greenfeld A, Rozenman J, et al. Pulmonary alveolar proteinosis: step-by-step perioperative care of whole lung lavage procedure. Heart Lung. 2002;31:43–9.
Sivitanidis E, Tosson R, Wiebalck A, et al. Combination of extracorporeal membrane oxygenation (ECMO) and pulmonary lavage in a patient with pulmonary alveolar proteinosis. Eur J Cardiothorac Surg. 1999;15:370–2.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Reddy, C. (2013). Whole-Lung Lavage. In: Ernst, A., Herth, F. (eds) Principles and Practice of Interventional Pulmonology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4292-9_71
Download citation
DOI: https://doi.org/10.1007/978-1-4614-4292-9_71
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-4291-2
Online ISBN: 978-1-4614-4292-9
eBook Packages: MedicineMedicine (R0)