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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

Effluent fluid became clearer
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Figure 0003: Effluent fluid became clearer

Mentions: The patient again was scheduled after 1 week for left-sided WLL where the same anesthesia and ventilation techniques were used. This time 6 L of warm heparinized saline were used until the effluent became clear [Figure 3]. The patient was extubated and shifted to HDU. Her postoperative period was smooth and eventually she was shifted to the ward on the next day. The patient did well after the procedure, maintaining saturation 98% oxygen on room air. Postoperative PFTs were done and she showed slight improvement. The patient was discharged in good condition to be seen in the clinic after 1 month.


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)

Effluent fluid became clearer
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Effluent fluid became clearer
Mentions: The patient again was scheduled after 1 week for left-sided WLL where the same anesthesia and ventilation techniques were used. This time 6 L of warm heparinized saline were used until the effluent became clear [Figure 3]. The patient was extubated and shifted to HDU. Her postoperative period was smooth and eventually she was shifted to the ward on the next day. The patient did well after the procedure, maintaining saturation 98% oxygen on room air. Postoperative PFTs were done and she showed slight improvement. The patient was discharged in good condition to be seen in the clinic after 1 month.

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