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Postgraduate Education Corner: PROCEDURE VIDEOS ONLINE |

Whole-Lung Lavage for Pulmonary Alveolar Proteinosis

Gaëtane Michaud, MD; Chakravarthy Reddy, MD; Armin Ernst, MD
Author and Funding Information

Affiliations: From the Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA.

Correspondence to: Armin Ernst, MD, Chief, Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Deaconess Building 201, Boston, MA 02215; e-mail: aernst@bidmc.harvard.edu


Editor's Note:In this series, the article is intended to complement a video, available at [http://chestjournal.chestpubs.org/site/misc/videos/media1/index.html]. The video contains footage and narration to accompany the text, from clinical background through postprocedural care. The first time you access the video, you may be asked to update your Web browser's Flash Player plugin. If you are not automatically prompted to update the plugin, you can download the latest version of the Flash Player for free by visiting http://www.adobe.com/go/getflash.

For editorial comment see page 1447

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1678-1681. doi:10.1378/chest.09-2295
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Pulmonary alveolar proteinosis (PAP) is a disease characterized by the deposition of amorphous lipoproteinaceous material in the alveoli secondary to abnormal processing of surfactant by macrophages. Whole-lung lavage often is performed as the first line of treatment for this disease because it is a means to wash out the proteinaceous material from the alveoli and reestablish effective oxygenation and ventilation. Whole-lung lavage is a large-volume BAL that is performed mainly in the treatment of PAP. In brief, it involves the induction of general anesthesia followed by isolation of the two lungs with a double-lumen endotracheal tube and performance of single-lung ventilation while large-volume lavages are performed on the nonventilated lung. Warmed normal saline solution in 1-L aliquots (total volumes up to 20 L) is instilled into the lung, chest physiotherapy is performed, then the proteinaceous effluent is drained with the aid of postural positioning. The sequence of events is repeated until such time as the effluent, which is initially milky and opaque, becomes clear. This procedure results in significant clinical and radiographic improvement secondary to the washing out of the proteinaceous material from the alveoli. The whole-lung lavage video details all aspects of the procedure, including case selection, patient preparation and equipment, a step-by-step review of the procedure, and postoperative considerations.

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Whole Lung Lavage

Running Time: 17:08

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