Whole-lung lavage generally is well tolerated. The major potential complication is intraoperative refractory, which tends to be more common while the first lung is being lavaged. Low oxygen saturations (percentages in the high 70s to 80s) are not uncommon early in the procedure; however, they generally improve throughout the case without any other intervention. Hyperbaric oxygen, cardiopulmonary bypass, and temporary venovenous extracorporeal gas exchange all have been used in the past, but in more recent studies,7 they have not been found to be necessary in most cases. Other more common and less dangerous complications include pneumothorax, pleural effusion, and hydropneumothorax, which can be avoided by meticulous charting of the infused saline solution and the output, and by taking care not to allow instilled fluid to exceed the fluid drained by more than a few hundred milliliters in consecutive lavages. Spillage of lavage fluid into the contralateral (ventilated) lung also may occur and should be considered if an imbalance is noted between the instilled and the drained volumes. If spillage is a concern, then any excess fluid should be aspirated from the ventilated lung and the dual-lumen endotracheal tube should be readjusted to ensure no further ongoing leak.