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Continuous positive airway pressure ventilation during whole lung lavage for treatment of alveolar proteinosis -A case report and review of literature.

El-Dawlatly A, Hajjar W, Alnassar S, Alsafar R, Abodonya A - Saudi J Anaesth (2011)

Bottom Line: In conclusion, anesthesia in alveolar proteinosis for patients undergoing WLL is challenging to the anesthesiologist.It requires meticulous preoperative preparation with antibiotics, mucolytics and chest physiotherapy.Also it requires careful intraoperative monitoring and proper oxygenation especially during the suctioning phase of the lavaged fluid.

View Article: PubMed Central - PubMed

Affiliation: College of Medicine, King Saud University, Riyadh, KSA.

ABSTRACT
Pulmonary alveolar proteinosis (PAP) is a rare disease that affects young population usually in the age group of 20-40 years, characterized by the deposition of lipoproteinacious material in the alveoli secondary to abnormal processing of surfactant by macrophages. We report a case of a 15-year-old female who had history of cough with sputum for 3 days along with fever. She was seen in another hospital and was treated as a case of pneumonia where she received antibiotic but with no improvement. Computerized tomography (CT) chest showed diffuse interlobular septal thickening in the background of ground glass opacity giving a picture of crazy paving pattern which was consistent with the diagnosis of PAP. The patient was scheduled to undergo, first right-sided whole lung lavage (WLL) under general anesthesia. Endobronchial intubation using left sided 37 Fr double lumen tube. Continuous positive airway pressure (CPAP) as described in our previously published report was connected to the right lumen of the endobronchial tube. CPAP ventilation was used during the suctioning of lavage fluid phase in order to improve oxygenation. WLL was done using 5 L of warm heparinized saline (500 i.u/litre). The same procedure was repeated on the left side using 6 L of heparinized normal saline solution. In conclusion, anesthesia in alveolar proteinosis for patients undergoing WLL is challenging to the anesthesiologist. It requires meticulous preoperative preparation with antibiotics, mucolytics and chest physiotherapy. Also it requires careful intraoperative monitoring and proper oxygenation especially during the suctioning phase of the lavaged fluid. With this second case report of successful anesthetic management using the modified CPAP system we recommend with confidence the application of CPAP ventilation to improve oxygenation during WLL.

No MeSH data available.


Related in: MedlinePlus

CT lung scan showing crazy paving pattern
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Figure 0001: CT lung scan showing crazy paving pattern

Mentions: A 15-year-old female who had history of cough with sputum for 3 days along with fever was presented to us. She was seen in another hospital and was treated as a case of pneumonia where she received antibiotic but with no improvement. She was still having shortness of breath, so H1N1 was suspected; however, she was investigated with negative findings. Her previous medical history showed that she had chronic history of cough, easy fatigue-ability and shortness of breath on mild exertion. Her family history showed that her sister died from chronic respiratory disease, and also her two brothers have similar symptoms and they suffered from chronic lung disease. Further investigations were done including CT chest which showed diffuse interlobular septal thickening in the background of ground glass opacity giving a picture of crazy paving pattern with multiple patchy air space consolidation more on the lower lobes with air bronchogram [Figure 1]. After that the patient was sent for lung biopsy. Open lung biopsy done, which confirmed PAP. The patient was transferred to our hospital for WLL. Upon receiving she was conscious on oxygen (oxygen saturation 97% on 2-3 L of O2), pulse rate 96 beats/min, blood pressure 115/60 mmHg, respiratory rate was 24/min and body temperature was 36.8ºC. Biochemical analysis data were all within normal ranges. Arterial blood gases on room air were: PaO272.4 mmHg, PaCO2 34.9 mmHg, pH 7.426 and HCO3 2.4 mmol/L. Pulmonary function tests (PFTs) done and showed restrictive pattern.


Continuous positive airway pressure ventilation during whole lung lavage for treatment of alveolar proteinosis -A case report and review of literature.

El-Dawlatly A, Hajjar W, Alnassar S, Alsafar R, Abodonya A - Saudi J Anaesth (2011)

CT lung scan showing crazy paving pattern
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3101759&req=5

Figure 0001: CT lung scan showing crazy paving pattern
Mentions: A 15-year-old female who had history of cough with sputum for 3 days along with fever was presented to us. She was seen in another hospital and was treated as a case of pneumonia where she received antibiotic but with no improvement. She was still having shortness of breath, so H1N1 was suspected; however, she was investigated with negative findings. Her previous medical history showed that she had chronic history of cough, easy fatigue-ability and shortness of breath on mild exertion. Her family history showed that her sister died from chronic respiratory disease, and also her two brothers have similar symptoms and they suffered from chronic lung disease. Further investigations were done including CT chest which showed diffuse interlobular septal thickening in the background of ground glass opacity giving a picture of crazy paving pattern with multiple patchy air space consolidation more on the lower lobes with air bronchogram [Figure 1]. After that the patient was sent for lung biopsy. Open lung biopsy done, which confirmed PAP. The patient was transferred to our hospital for WLL. Upon receiving she was conscious on oxygen (oxygen saturation 97% on 2-3 L of O2), pulse rate 96 beats/min, blood pressure 115/60 mmHg, respiratory rate was 24/min and body temperature was 36.8ºC. Biochemical analysis data were all within normal ranges. Arterial blood gases on room air were: PaO272.4 mmHg, PaCO2 34.9 mmHg, pH 7.426 and HCO3 2.4 mmol/L. Pulmonary function tests (PFTs) done and showed restrictive pattern.

Bottom Line: In conclusion, anesthesia in alveolar proteinosis for patients undergoing WLL is challenging to the anesthesiologist.It requires meticulous preoperative preparation with antibiotics, mucolytics and chest physiotherapy.Also it requires careful intraoperative monitoring and proper oxygenation especially during the suctioning phase of the lavaged fluid.

View Article: PubMed Central - PubMed

Affiliation: College of Medicine, King Saud University, Riyadh, KSA.

ABSTRACT
Pulmonary alveolar proteinosis (PAP) is a rare disease that affects young population usually in the age group of 20-40 years, characterized by the deposition of lipoproteinacious material in the alveoli secondary to abnormal processing of surfactant by macrophages. We report a case of a 15-year-old female who had history of cough with sputum for 3 days along with fever. She was seen in another hospital and was treated as a case of pneumonia where she received antibiotic but with no improvement. Computerized tomography (CT) chest showed diffuse interlobular septal thickening in the background of ground glass opacity giving a picture of crazy paving pattern which was consistent with the diagnosis of PAP. The patient was scheduled to undergo, first right-sided whole lung lavage (WLL) under general anesthesia. Endobronchial intubation using left sided 37 Fr double lumen tube. Continuous positive airway pressure (CPAP) as described in our previously published report was connected to the right lumen of the endobronchial tube. CPAP ventilation was used during the suctioning of lavage fluid phase in order to improve oxygenation. WLL was done using 5 L of warm heparinized saline (500 i.u/litre). The same procedure was repeated on the left side using 6 L of heparinized normal saline solution. In conclusion, anesthesia in alveolar proteinosis for patients undergoing WLL is challenging to the anesthesiologist. It requires meticulous preoperative preparation with antibiotics, mucolytics and chest physiotherapy. Also it requires careful intraoperative monitoring and proper oxygenation especially during the suctioning phase of the lavaged fluid. With this second case report of successful anesthetic management using the modified CPAP system we recommend with confidence the application of CPAP ventilation to improve oxygenation during WLL.

No MeSH data available.


Related in: MedlinePlus