Acute and Critical Care

Airway Obstruction and Flattening of Arterial Pressure Wave during Whole Lung Lavage: A Case Report: Hyun Jung Koh, Sung Jin Hong, Ho Kyung Song, Ji Young Lee, Jin Young Chon, Ho Sik Moon, Yu Mi Ju, Hyung Mook Lee; Korean J Crit Care Med. 2013;28(2):133-136.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.133

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Abstract PDF: Whole lung lavage (WLL) is a challenging procedure; because lavage fluid may perturb the respiratory and hemodynamic systems. We observed severe airway obstruction and flattening arterial pressure wave during WLL for treatment of pulmonary alveolar proteinosis. The aim of this case report is to discuss the anesthetic requirement in order to prevent bronchospasm during WLL. Furthermore, we discuss the potential of lavage fluid to cause airway obstruction and decrease cardiac outflow through the mass effect.

Anesthetic Management of Whole-Lung Lavage Using Propofol-Remifentanil in a Patient with Pulmonary Alveolar Proteinosis: Ji Hyeon Lee, Chan Jong Chung, Ji Na Oh, Byung Ju Ko, So Ron Choi; Korean J Crit Care Med. 2012;27(3):173-178.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.173

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Pulmonary alveolar proteinosis (PAP) is characterized by the progressive accumulation of phospholipids and proteins within the alveolar sacs without producing an inflammatory response. Whole-lung lavage (WLL) is performed as the standard therapy for this disease because it serves to wash out the proteinaceous material from the alveoli. In this case, we performed sequential WLL using propofol-remifentanil, which is not related to hypoxic pulmonary vasoconstriction during one-lung ventilation. The patient's symptoms and radiologic findings showed improvement without the occurrence of any specific complications. Therefore, we report a case of anesthetic management of WLL performed repeatedly for a patient with recurrent PAP.

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Whole lung lavage using a rapid infusion system to treat a patient with pulmonary alveolar proteinosis
Seung Won Ra, Soon Eun Park, Hyung Kwan Lee, Il Sang Han, Se Hun Park
Yeungnam University Journal of Medicine.2020; 37(1): 67. CrossRef

Anesthetic Management for Sequential Bronchoalveolar Lavage in a Patient with Pulmonary Alveolar Proteinosis: A case report: You Seong Jeong, Hee Joo Kim, Jae Hwan Kim, Myoung Hoon Kong, Mi Kyeong Lee, Nan Suk Kim, Young Seok Choi, Sang Ho Lim; Korean J Crit Care Med. 1998;13(2):243-248.

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Abstract PDF: Pulmonary alveolar proteinosis is a rare disease of unknown etiology characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar space in the absence of inflammatory response. The removal of lipoproteinaceous material from the alveolar can the only means of effectively treating the progressive hypoxemia in pulmonary alveolar proteinosis. Bronchoalveolar lavage using a double-lumen endotracheal tube is an accepted modality for treatment of pulmonary alveolar proteinosis. We had utilized sequential bronchoalveolar lavage successfully for the treatment of a 51 year-old male patient with pulmonary alveolar proteinosis. There was no hypoxemia and unstable hemodynamics during the procedure. We conclude that the procedure will be safely performed by careful monitoring.

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