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Review
. 2017 Jun;9(6):1697-1706.
doi: 10.21037/jtd.2017.04.10.

Whole lung lavage-technical details, challenges and management of complications

Ahmed Awab  1 , Muhammad S Khan  1 , Houssein A Youness  1
Affiliations
Review

Whole lung lavage-technical details, challenges and management of complications

Ahmed Awab et al. J Thorac Dis. 2017 Jun.

Abstract

Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by alveolar accumulation of surfactant material with resulting hypoxemia and reduced lung function. Whole lung lavage (WLL) to physically remove the proteinaceous material from the affected lung is the standard treatment. Since its original description in 1964, there have been increasing numbers of WLL procedures done worldwide and the technique has been variously refined and modified. When done in experienced centers, WLL provides long lasting benefit in the majority of patients. It is considered safe and effective. There are no guidelines standardizing the procedure. Our preferred method is to lavage one lung at a time, with the patient supine, filling to functional residual capacity (FRC) and repeating cycles of drainage and instillation with chest percussion until the effluent is clear. The aim of this article is to provide a detailed description of the technique, equipment needed and logistic considerations as well as providing a physiologic rationale for each step of WLL. We will also review the available data concerning variations of the technique described in the literature.

Keywords: Pulmonary alveolar proteinosis (PAP); rare disease; whole lung lavage (WLL).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Placement of DLT. Left upper panel: left sided double lumen tube; right upper panel: DLT in place. Left Lower panel: bronchoscopic confirmation of distal balloon in left main stem; right lower panel: testing for effective lung isolation (presence of bubbles indicates inadequate lung isolation). DLT, double lumen endotracheal tube.
Figure 2
Figure 2
WLL equipment. Left upper panel: warming basin; right upper panel: Y-connector. Left lower panel: Y-connector attached to the DLT; right lower panel: wrap around vest for percussion. WLL, whole lung lavage; DLT, double lumen endotracheal tube.
Figure 3
Figure 3
WLL setup. A left sided double lumen ET tube allows isolation of both lungs. A Y connector is attached from one side to the target lung ET tube and from the other side to the lavage fluid and to the drainage fluid container. Clamps allow the pulmonologist to control the flow of the fluid in and out of the lavaged lung.
Figure 4
Figure 4
Sample worksheet for WLL (single lung technique). WLL, whole lung lavage.
See this image and copyright information in PMC

References

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