Abstract
BackgroundPulmonary alveolar proteinosis is a rare disorder characterized by alveolar obstruction secondary to the collection of lipoproteinaceous material in the alveoli leading to a spectrum of respiratory illness ranging from mild to severe respiratory failure. Whole lung lavage considered the gold standard for the treatment of PAP is performed under general anesthesia and presents a unique set of challenges to the anesthesiologist. The procedure involves manually removing the lipoproteinacious material by repeating aliquots of fluids and draining periodically after percussion. When done effectively it is quite effective and life-saving procedure.Case presentationA 39-year-old female presented with history of gradually progressive shortness of breath, diagnosed to have primary pulmonary alveolar proteinosis for which bilateral whole lung lavage was planned. During the lavage cycles, patient had episodes of desaturation to 60% during which the double lung ventilation was resumed. Her serial ABG revealed a deteriorating oxygenation. In view of increased oxygen requirements, the procedure was carried out in two stages. She made a complete recovery after the procedure.ConclusionsA multidisciplinary team working with good communication, use of adequate back up plans, meticulous lung separation with double lumen tube, vigilant intraoperative monitoring, short-term postoperative ventilation go a long way in achieving adequate gas exchange in patients with respiratory failure due to pulmonary alveolar proteinosis.
Highlights
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by alveolar obstruction secondary to the collection of lipoproteinaceous material in the alveoli leading to a spectrum of respiratory illness ranging from mild to severe respiratory failure (Rosen et al 1958)
Whole lung lavage (WLL) considered the gold standard for the treatment of PAP is performed under general anesthesia and presents a unique set of challenges to the anesthesiologist
We report the successful conduct of a two stage whole lung lavage in a case of PAP with respiratory failure
Summary
A multidisciplinary team working with good communication, use of adequate back up plans, meticulous lung separation with DLT tube, appropriate ventilatory monitoring with adequate use of PEEP, vigilant intraoperative monitoring, short-term postoperative ventilation go a long way in achieving adequate gas exchange in patients with respiratory failure due to pulmonary alveolar proteinosis. PB helped in the editing and writing of the manuscript. Both MM and PB helped in the basic outline of the manuscript. The authors read and approved the final manuscript. Availability of data and materials The data was extracted from the medical records file of the patient and the materials are being used which were available in our set up with valid reasons. Consent for publication Written permission/consent for reproduction of images of the patient for the purpose of publication in an educational medical journal was obtained from the patient. Competing interests The authors declare that they have no competing interests
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