Whole Lung Lavage of Nine Children with Pulmonary Alveolar Proteinosis: Experience in a Tertiary Lung Center
A 6 year old girl underwent first ten cycles of WLL with using PCPB without complication. Catheters were introduced in the RIJV and in the RCA. 4 months later, the patient suffered another progressive respiratory impairment. We attempted the second WLL with the same method and the patient remained stable throughout the procedure. She was discharged from the hospital after 5 days, with a marked improvement of her functional class. 2 months later, the third lavage was done on both lungs without PCPB due to recurrence of the disease. Under anesthesia, a 6 mm cuffed single lumen endotracheal tube was placed. Then under fiberoptic bronchoscopic guidance a bronchial blocker was advanced into the targeted main bronchus to achieve lung separation. The patient remained stable throughout the procedure, which allowed bilateral sequential WLL in the same session. She was discharged 11 days later.\nAt age 9, weight 22 kg, she underwent the fourth WLL due to marked decreased exercise tolerance, severe hypoxemia and cyanosis. This time a 28 DLT was intubated under general anesthesia in order to selectively ventilate and lavage each lung. First the left lung and then the right lung was lavaged independently. The patient tolerated the procedure quite well. She was discharged 2 days later after a marked improvement of her functional class. At present (2 years after last WLL) the patient requires further lung lavage due to recurrence of the illness.