Case report

Anaesthesia for serial whole-lung lavage in a patient with severe pulmonary alveolar proteinosis: a case report

Stephen T Webb , Adrian JR Evans , A James Varley and Andrew A Klein

Department of Anaesthesia & Intensive Care, Papworth Hospital, Cambridge CB23 3RE, UK

author email corresponding author email

Journal of Medical Case Reports 2008, 2:360doi:10.1186/1752-1947-2-360

Published:	27 November 2008

Abstract

Introduction

Pulmonary alveolar proteinosis is a rare condition that requires treatment by whole-lung lavage. We report a case of severe pulmonary alveolar proteinosis and discuss a safe and effective strategy for the anaesthetic management of patients undergoing this complex procedure.

Case presentation

A 34-year-old Caucasian man was diagnosed with severe pulmonary alveolar proteinosis. He developed severe respiratory failure and subsequently underwent serial whole-lung lavage. Our anaesthetic technique included the use of pre-oxygenation, complete lung separation with a left-sided double-lumen endotracheal tube, one-lung ventilation with positive end-expiratory pressure, appropriate ventilatory monitoring, cautious use of positional manoeuvres and single-lumen endotracheal tube exchange for short-term postoperative ventilation.

Conclusion

Patients with pulmonary alveolar proteinosis may present with severe respiratory failure and require urgent whole-lung lavage. We have described a safe and effective strategy for anaesthesia for whole-lung lavage. We recommend our anaesthetic technique for patients undergoing this complex and uncommon procedure.