Abstract OR001

Abstract

Introduction: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of proteinaceous material in the alveoli leading to varying degrees of impairment in gas exchange. We experienced a patient with PAP who underwent therapeutic whole lung lavage (LL) utilizing veno-arterial extracorporeal membrane oxygenation (ECMO). Case report: A 34-year-old man, a smoker, suffering from PAP presented with progressive exertional dyspnea and cough. He was receiving oxygen at 4L/min via face mask, his SpO2 was 87%. The patient was managed with whole lung lavage using double-lumen tube under general anaesthesia. The percutaneous veno-arterial ECMO was instituted before lavage. The left lung (LL) was lavaged first, using 9.4 L of warmed (at 37°C) normal saline with a return of 9.1 L over a period of 330 min. After 3 days, the right lung (RL) was lavaged with a total of 9 L, requiring 420 min to complete. He was extubated at the end of the both procedure without any problem and transferred to the ICU. ECMO support was terminated 3 days after second lavage. He was discharged without oxygen support 3 days later. Discussion: When a patient with PAP has severe hypoxemia prior to the lavage procedure, WLL utilizing ECMO should be considered in order to avoid severe hypoxaemia with fatal consequences during lavage (1).