Whole lung lavage

Whole Lung Lavage (WLL) is a medical procedure used to wash out the contents of the lungs. It is primarily used to treat pulmonary alveolar proteinosis (PAP), a rare lung condition where protein and lipid material accumulates within the alveoli, leading to respiratory distress and impaired gas exchange. The procedure involves the sequential washing of the lungs with saline to remove the accumulated material.

Procedure

Whole Lung Lavage is performed under general anesthesia with the patient intubated using a double-lumen endotracheal tube. This tube allows one lung to be ventilated while the other is being washed. The procedure starts with the affected lung, which is isolated and filled with saline solution. The saline is then drained, along with the accumulated material. This process is repeated several times until the effluent becomes clear, indicating that most of the material has been removed. The procedure is then repeated on the other lung if necessary.

Indications

The primary indication for Whole Lung Lavage is pulmonary alveolar proteinosis, a condition that can lead to significant respiratory compromise. While the exact cause of PAP is not fully understood, it is believed to involve the accumulation of surfactant due to impaired clearance by alveolar macrophages. Other potential indications for WLL include certain cases of pulmonary fibrosis, pneumoconiosis, and other diseases where foreign material accumulates in the lungs.

Risks and Complications

As with any procedure involving general anesthesia and intubation, there are risks associated with Whole Lung Lavage. These can include, but are not limited to, pneumothorax (collapsed lung), hypoxemia (low blood oxygen), pulmonary edema (fluid in the lungs), and infection. Careful patient selection and monitoring during the procedure are essential to minimize these risks.

Outcomes

Patients with pulmonary alveolar proteinosis often experience significant improvement in respiratory function and quality of life following Whole Lung Lavage. The procedure may need to be repeated periodically, as PAP can recur. The frequency of lavage depends on the patient's symptoms and lung function tests.

History

Whole Lung Lavage has been used as a treatment for pulmonary alveolar proteinosis since the 1960s. Over the years, the technique has been refined, but the basic principle remains the same. It was initially the only effective treatment for PAP until the discovery of granulocyte-macrophage colony-stimulating factor (GM-CSF) therapy, which has emerged as a non-invasive alternative for some patients.

See Also

• Pulmonary alveolar proteinosis
• Pulmonary fibrosis
• Pneumoconiosis
• Granulocyte-macrophage colony-stimulating factor

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  Pulmonary alveolar proteinosis under high magnification

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  0.9% NaCl solution 500ml

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  Carlens double-lumen endotracheal tube