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Critical Care: Critical Care |

Alveolar Proteinosis in Extremis: A Critical Case Treated With Whole Lung Lavage Without Extracorporeal Membrane Oxygenation

Wen-Liang Guo, MD; Shi-Yue Li, MD
Author and Funding Information

State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A142. doi:10.1016/j.chest.2016.02.148
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SESSION TITLE: Critical Care

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a syndrome arising from altered surfactant homeostasis. Pathophysiologically, the major changes involve impaired pulmonary diffusion and ventilation/perfusion mismatch, which may result in respiratory failure[1]. Whole lung lavage (WLL) is considered the standard treatment for progressive PAP leading to respiratory compromise[2]. In very rare cases where the patient has developed critical respiratory failure and can not tolerate single-lung ventilation, extracorporeal membrane oxygenation (ECMO) may be required to facilitate WLL[2-3]. This may bring up a question whether ECMO or hyperbaric conditions are always essential for WLL in PAP patients with critical respiratory failure. We present a life-threatening case of PAP requiring mechanical ventilation in which the patient was successfully managed by bilateral WLL under single lung ventilation alone. ECMO was nevertheless set up beforehand.

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