Whole Lung Lavage of Nine Children with Pulmonary Alveolar Proteinosis: Experience in a Tertiary Lung Center
An 11 year-old girl treated with multiple unilateral lavaging of each lung without CPB. At the first lavage, due to unavailability of the proper size of DLT and severity of the disease we lavaged the right lung by our invented method. Following induction of general anesthesia a 4.5 univent tracheal tube was inserted and the cuff of bronchial blocker was positioned at right main bronchus under fiberoptic bronchoscopic guide and positive pressure ventilation was established with FIO2 1.0. In order to independently ventilate the left lung during lavage of right lung, an 8 French sized nasogastric tube was inserted along with the univent tube to reach the distal end of the right main bronchus with bronchoscopic visualization. The right lung was lavaged by multiple instillation of warm normal saline via the nasogastric tube while the left lung was ventilated with 100% oxygen. The patient was stable during the 9 hours procedure. Following clearance of aspirated fluid, the univent tube was exchanged for a single lumen tracheal tube. After eight days, the left lung was lavaged uneventfully under one lung ventilation anesthesia using a 26 left DLT. Lavage of the right lung and the left lung was again conducted successfully with a similar procedure 2 and 4 months later, respectively. At present (at the age of 20), she has no evidence of PAP recurrence.