Öz
Background: Pulmonary alveolar proteinosis is a pathology that causes ventilation impairment secondary to protein accumulation in the alveoli. Massive bronchoalveolar lavage (MBL) is the main approach in the treatment of pulmonary alveolar proteinosis and is useful in improving ventilation and reducing the need for oxygen support in patients. In this article, we aim to present the anaesthetic approach during MBL performed in the left and right lungs at a 1-month interval in the case of PAP.
Case Presentation: A 40-year-old male patient with a diagnosis of PAP was admitted for therapeutic lavage under general anaesthesia with appropriate hemodynamic monitoring. Two lavage procedures performed with a 4-week interval were successfully completed and the patient showed clinical improvement.
Conclusion: MBL is a rare and complicated procedure. It is important to provide adequate lavage fluid and heating before the procedure. In addition, special preparation is required for the necessary equipment and monitoring. In the presence of an experienced multidisciplinary team, we believe that the procedure will be safe and beneficial and will improve the patient's quality of life.
Anahtar Kelimeler
Massive Bronchoalveolar Lavage Pulmonary Alveolar Proteinosis Hypoxia
Kaynakça
- 1. Danel C, Israel-Biet D, Costabel U, Klech H: Therapeutic applications of bronchoalveoler lavage. Eur Respir J 5:1173, 1992.
- 2. Rosen SH, Castleman B, Liebow AA. Pulmonary alveolar proteinosis. N Engl J Med. 1958 Jun 5;258(23):1123-42. doi: 10.1056/NEJM195806052582301.
- 3. Claypool WD, Rogers RM, Matuschak GM. Update on the clinical diagnosis, management, and pathogenesis of pulmonary alveolar proteinosis (phospholipidosis). Chest. 1984 Apr;85(4):550-8. doi: 10.1378/chest.85.4.550. 4. Divertie MB, Brown AL, Harrison EG: Pulmonary alveolar proteinosis: two cases studied by electron microscopy. Am J Med 40:351, 1966.
- 5. Benumof JL: Anesthesia for Thoracic Surgery. 2nd Ed., W.B. Saunders Company Press, Philadelphia, 548-55, 1995.
- 6. Shah PL, Hansell D, Lawson PR, Reid KB, Morgan C. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis. Thorax. 2000 Jan;55(1):67-77. doi: 10.1136/thorax.55.1.67.
- 7. Spragg RG, Benumof JL, Alfery DD. New methods for the performance of unilateral lung lavage. Anesthesiology. 1982 Dec;57(6):535-8. doi: 10.1097/00000542-198212000-00018.
- 8. Martínez-López MA, Gómez-Cerezo G, Villasante C, Molina F, Diaz S, Cobo J, Medraño C. Pulmonary alveolar proteinosis: prolonged spontaneous remission in two patients. Eur Respir J. 1991 Mar;4(3):377-9.
- 9. Valade DR, Stix MS, Gray AW Jr. Use of level 1(R) warmer for lavage fluid during bilateral pulmonary lavage. Anesth Analg. 2000 Feb;90(2):501. doi: 10.1097/00000539-200002000-00057.
- 10. Lippmann M, Mok MS. Anesthetic management of pulmonary lavage in adults. Anesth Analg. 1977 Sep-Oct;56(5):661-8. doi: 10.1213/00000539-197709000-00012.
- 11. Çamcı E, Bostancı K, Şentürk M, Toker A, Ece T, Tuğrul M: Bronkoalveoler Lavaj’da genel anestezi uygulaması (olgu sunumu). Türk Anesteziyoloji ve Reanimasyon Cemiyeti Mecmuası 27:454, 1999.
- 12. Loubser PG. Validity of pulmonary artery catheter-derived hemodynamic information during bronchopulmonary lavage. J Cardiothorac Vasc Anesth. 1997 Dec;11(7):885-8. doi: 10.1016/s1053-0770(97)90128-2. 13. Hunter Guevara LR, Gillespie SM, Klompas AM, Torres NE, Barbara DW. Whole-lung lavage in a patient with pulmonary alveolar proteinosis. Ann Card Anaesth. 2018 Apr-Jun;21(2):215-217. doi: 10.4103/aca.ACA_184_17.
- 14. Sazak HG, Sahin S, Pehlivanoğlu P, Cakır O, Tunç M, Ulus F, Akkalyoncu B, Samurkaşoğlu B. An uncommon procedure for a rare ailment: massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis. Balkan Med J. 2012 Sep;29(3):334-8. doi: 10.5152/balkanmedj.2012.046. Epub 2012 Sep 1.
- 15. Wołoszczak J, Wrześniewska M, Hrapkowicz A, Janowska K, Szydziak J, Gomułka K. A Comprehensive Outlook on Pulmonary Alveolar Proteinosis-A Review. Int J Mol Sci. 2024 Jun 28;25(13):7092. doi: 10.3390/ijms25137092.
Öz
Kaynakça
- 1. Danel C, Israel-Biet D, Costabel U, Klech H: Therapeutic applications of bronchoalveoler lavage. Eur Respir J 5:1173, 1992.
- 2. Rosen SH, Castleman B, Liebow AA. Pulmonary alveolar proteinosis. N Engl J Med. 1958 Jun 5;258(23):1123-42. doi: 10.1056/NEJM195806052582301.
- 3. Claypool WD, Rogers RM, Matuschak GM. Update on the clinical diagnosis, management, and pathogenesis of pulmonary alveolar proteinosis (phospholipidosis). Chest. 1984 Apr;85(4):550-8. doi: 10.1378/chest.85.4.550. 4. Divertie MB, Brown AL, Harrison EG: Pulmonary alveolar proteinosis: two cases studied by electron microscopy. Am J Med 40:351, 1966.
- 5. Benumof JL: Anesthesia for Thoracic Surgery. 2nd Ed., W.B. Saunders Company Press, Philadelphia, 548-55, 1995.
- 6. Shah PL, Hansell D, Lawson PR, Reid KB, Morgan C. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis. Thorax. 2000 Jan;55(1):67-77. doi: 10.1136/thorax.55.1.67.
- 7. Spragg RG, Benumof JL, Alfery DD. New methods for the performance of unilateral lung lavage. Anesthesiology. 1982 Dec;57(6):535-8. doi: 10.1097/00000542-198212000-00018.
- 8. Martínez-López MA, Gómez-Cerezo G, Villasante C, Molina F, Diaz S, Cobo J, Medraño C. Pulmonary alveolar proteinosis: prolonged spontaneous remission in two patients. Eur Respir J. 1991 Mar;4(3):377-9.
- 9. Valade DR, Stix MS, Gray AW Jr. Use of level 1(R) warmer for lavage fluid during bilateral pulmonary lavage. Anesth Analg. 2000 Feb;90(2):501. doi: 10.1097/00000539-200002000-00057.
- 10. Lippmann M, Mok MS. Anesthetic management of pulmonary lavage in adults. Anesth Analg. 1977 Sep-Oct;56(5):661-8. doi: 10.1213/00000539-197709000-00012.
- 11. Çamcı E, Bostancı K, Şentürk M, Toker A, Ece T, Tuğrul M: Bronkoalveoler Lavaj’da genel anestezi uygulaması (olgu sunumu). Türk Anesteziyoloji ve Reanimasyon Cemiyeti Mecmuası 27:454, 1999.
- 12. Loubser PG. Validity of pulmonary artery catheter-derived hemodynamic information during bronchopulmonary lavage. J Cardiothorac Vasc Anesth. 1997 Dec;11(7):885-8. doi: 10.1016/s1053-0770(97)90128-2. 13. Hunter Guevara LR, Gillespie SM, Klompas AM, Torres NE, Barbara DW. Whole-lung lavage in a patient with pulmonary alveolar proteinosis. Ann Card Anaesth. 2018 Apr-Jun;21(2):215-217. doi: 10.4103/aca.ACA_184_17.
- 14. Sazak HG, Sahin S, Pehlivanoğlu P, Cakır O, Tunç M, Ulus F, Akkalyoncu B, Samurkaşoğlu B. An uncommon procedure for a rare ailment: massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis. Balkan Med J. 2012 Sep;29(3):334-8. doi: 10.5152/balkanmedj.2012.046. Epub 2012 Sep 1.
- 15. Wołoszczak J, Wrześniewska M, Hrapkowicz A, Janowska K, Szydziak J, Gomułka K. A Comprehensive Outlook on Pulmonary Alveolar Proteinosis-A Review. Int J Mol Sci. 2024 Jun 28;25(13):7092. doi: 10.3390/ijms25137092.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Case Report/Case Series |
| Yazarlar | |
| Erken Görünüm Tarihi | 28 Nisan 2025 |
| Yayımlanma Tarihi | 1 Mayıs 2025 |
| Gönderilme Tarihi | 21 Mart 2025 |
| Kabul Tarihi | 28 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 1 Sayı: 1 |
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