Pulmonary lavage in a case of alveolar proteinosis

A case of alveolar proteinosis is reported which was treated by lung lavage. The technique requires a Robertshaw double-lumen tube to isolate each lung. Initial ventilation with 100% oxygen removes lung nitrogen and the first 500 ml of saline occupies part of the functional reserve capacity and is not recovered. Lavage is then continued with 500-ml aliquots until the washings become clear. Monitoring the oxygen--haemoglobin saturation by ear-oximetry showed changes of between 15 and 20%, falling during suction and rising during infusion of lavage fluid. At the end of lavage, gas exchange is severely impaired by retained saline and a variable period of controlled ventilation may be required.