• Robert M DiBlasi, David Crotwell, Jeremy M Geiduscheck, Peter Richardson, Austin Smith, John W Salyer, and Margaret Rosenfeld.
• Respiratory Care Department, Seattle Children's Hospital, Seattle, WA, USA. robert.diblasi@seattlechildrens.org
• Pediatr Crit Care Me. 2010 May 1; 11 (3): e28-31.

ObjectivePulmonary alveolar proteinosis is a rare condition that can cause life-threatening respiratory failure attributable to excessive alveolar accumulation of surfactant proteins. The standard treatment for removing these secretions is through therapeutic bilateral lung lavage. Descriptions of procedures for performing therapeutic bilateral lung lavage and methods used to evaluate the overall effectiveness of this invasive procedure in children with pulmonary alveolar proteinosis have not been adequately described in the medical literature. We successfully and safely performed therapeutic bilateral lung lavage and obtained lung mechanics measurements in a child with pulmonary alveolar proteinosis.DesignCase report.SettingOperating room within a pediatric hospital.Patients/SubjectsA 13-yr-old boy with pulmonary alveolar proteinosis requiring serial therapeutic bilateral lung lavage for recurrent respiratory distress.InterventionsThe patient presented to the hospital operating room for therapeutic lung lavage after a recent history of progressive dyspnea, respiratory distress, declining lung function measurements, and worsening radiographic abnormalities. We obtained baseline spirometric and respiratory system compliance measurements before and after therapeutic bilateral lung lavage. The left lung was lavaged on the first day and the right lung was lavaged on the third day using selective endobronchial intubation and selective lung ventilation.ResultsThe procedure was well-tolerated and resulted in the removal of a significant volume of accumulated secretions. After the lavage, the patient demonstrated improvement in respiratory distress, chest radiograph appearance, lung compliance, and spirometric measurements.ConclusionsThis case report demonstrates that therapeutic bilateral lung lavage can be performed safely and effectively in a pediatric patient with pulmonary alveolar proteinosis by isolating individual lungs using a dual-lumen endotracheal tube. In this patient, therapeutic bilateral lung lavage was found to have a significant impact on lung function and mechanics after this procedure.

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