Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

Anesthetic management during whole-lung lavage using lung ultrasound in a patient with pulmonary alveolar proteinosis: a case report

  • Jung, Jae Wan (Division of Pulmonary Medicine, Department of Internal Medicine, Wonkwang University Hospital) ;
  • Lee, Hyunho (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Oh, Jimi (Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • Received : 2021.06.29
  • Accepted : 2021.08.21
  • Published : 2021.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by progressive accumulation of lipoprotein material in the lungs due to impaired surfactant clearance. Whole-lung lavage (WLL) is the current standard treatment and consists of sequential lavage of each lung to mechanically remove the residual material from the alveoli. Although WLL is considered safe, unexpected complications can occur. Moreover, due to the rarity of the disease itself, this procedure is unknown to many physicians, and management of intraoperative complications can be challenging for anesthesiologists. Lung ultrasound (LUS) provides reliable and valuable information for detecting perioperative pulmonary complications and, in particular, quantitation of lung water content. There have been reports on monitoring the different stages of controlled deaeration of the non-ventilated lung during WLL using LUS. However, it has been limited to non-ventilated lungs. Therefore, we report the use of LUS in WLL to proactively detect pulmonary edema in the ventilated lung and implement a safe and effective anesthesia strategy. Given the limited diagnostic tools available to anesthesiologists in the operating room, LUS is a reliable, fast, and noninvasive method for identifying perioperative pulmonary complications in patients with PAP undergoing WLL.

Keywords

References

  1. Ra SW, Park SE, Lee HK, Han IS, Park SH. Whole lung lavage using a rapid infusion system to treat a patient with pulmonary alveolar proteinosis. Yeungnam Univ J Med 2020;37:67-72. https://doi.org/10.12701/yujm.2019.00360
  2. Via G, Lichtenstein D, Mojoli F, Rodi G, Neri L, Storti E, et al. Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes. Intensive Care Med 2010;36:999-1007. https://doi.org/10.1007/s00134-010-1834-4
  3. Mata-Suarez SM, Castro-Lalin A, Mc Loughlin S, De Domini J, Bianco JC. Whole-lung lavage-a narrative review of anesthetic management. J Cardiothorac Vasc Anesth 2020 Dec 5 [Epub]. https://doi.org/10.1053/j.jvca.2020.12.002.
  4. Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J 2016;37:2097-104. https://doi.org/10.1093/eurheartj/ehw164
  5. Misra S, Das PK, Bal SK, Elayat A, Sahoo S, Dahl AB, et al. Therapeutic whole lung lavage for alveolar proteinosis. J Cardiothorac Vasc Anesth 2020;34:250-7. https://doi.org/10.1053/j.jvca.2019.07.001
  6. Ramachandran P, Chaudhury A, Devaraj U, Maheshwari KU, D'Souza G. Monitoring whole-lung lavage using lung ultrasound: the changing phases of the lung. Lung India 2018;35:350-3. https://doi.org/10.4103/lungindia.lungindia_344_17
  7. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 2015;147:1659-70. https://doi.org/10.1378/chest.14-1313
  8. Kumar A, Abdelmalak B, Inoue Y, Culver DA. Pulmonary alveolar proteinosis in adults: pathophysiology and clinical approach. Lancet Respir Med 2018;6:554-65. https://doi.org/10.1016/S2213-2600(18)30043-2
  9. Campo I, Luisetti M, Griese M, Trapnell BC, Bonella F, Grutters J, et al. Whole lung lavage therapy for pulmonary alveolar proteinosis: a global survey of current practices and procedures. Orphanet J Rare Dis 2016;11:115. https://doi.org/10.1186/s13023-016-0497-9
  10. Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis: progress in the first 44 years. Am J Respir Crit Care Med 2002;166:215-35. https://doi.org/10.1164/rccm.2109105
  11. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 34-1974. N Engl J Med 1974;291:464-9. https://doi.org/10.1056/NEJM197408292910909
  12. Huber GL, Edmunds LH Jr, Finley TN. Effect of experimental saline lavage on pulmonary mechanics and morphology. Am Rev Respir Dis 1971;104:337-47. https://doi.org/10.1164/arrd.1971.104.3.337
  13. McClenahan JB. Pulmonary alveolar proteinosis. Arch Intern Med 1974;133:284-7. https://doi.org/10.1001/archinte.1974.00320140122013
  14. Rupp GH, Wasserman K, Ogawa M, Heiner DC. Bronchopulmonary fluids in pulmonary alveolar proteinosis. J Allergy Clin Immunol 1973;51:227-37. https://doi.org/10.1016/0091-6749(73)90142-5
  15. Rogers RM, Szidon JP, Shelburne J, Neigh JL, Shuman JF, Tantum KR. Hemodynamic response of the pulmonary circulation to bronchopulmonary lavage in man. N Engl J Med 1972;286:1230-3. https://doi.org/10.1056/NEJM197206082862302
  16. Anile A, Russo J, Castiglione G, Volpicelli G. A simplified lung ultrasound approach to detect increased extravascular lung water in critically ill patients. Crit Ultrasound J 2017;9:13. https://doi.org/10.1186/s13089-017-0068-x
  17. Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, et al. "Ultrasound comet-tail images": a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 2005;127:1690-5. https://doi.org/10.1378/chest.127.5.1690
  18. Enghard P, Rademacher S, Nee J, Hasper D, Engert U, Jorres A, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care 2015;19:36. https://doi.org/10.1186/s13054-015-0756-5
  19. Leblanc D, Bouvet C, Degiovanni F, Nedelcu C, Bouhours G, Rineau E, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med 2014;40:1468-74. https://doi.org/10.1007/s00134-014-3382-9
  20. Goldstein LS, Kavuru MS, Curtis-McCarthy P, Christie HA, Farver C, Stoller JK. Pulmonary alveolar proteinosis: clinical features and outcomes. Chest 1998;114:1357-62. https://doi.org/10.1378/chest.114.5.1357