Whole-lung lavage in a toddler. Technical challenges and solutions
2016
Introduction:
Pulmonary alveolar proteinosisis a rare respiratory disease whose main treatment is the whole-
lung lavage. This could be a challenging procedure in small children. Objective: The aim of this report is to show our experience coping with a 21-month-old girl with
pulmonary alveolar proteinosis, who needed a whole-
lung lavagedue to persistent
hypoxemia. Case report: Our patient was a healthy girl until she was 7 months, when she was diagnosed with
myeloblastic leukemia. At the age of 13 months, a hematopoietic stem cell transplant was undergone after no response to chemotherapy. After a sepsis when she was 20 months, she had respiratory distress and
hypoxemiathat persisted for more than 2 weeks, so a chest CT was ordered; it showed bilateral
ground-glass opacities. A bronchoalveolar lavage plus a pulmonary biopsy were undergone, confirming the diagnosis of
pulmonary alveolar proteinosis. A whole-
lung lavagewas done, using simultaneously 2 endotracheal cuffed tubes: one (3.5 mm diameter) placed in the trachea to ventilate one lung and another of 3 mm (modified to make it longer) to instill heated saline into the
bronchusto perform the lavage. This procedure was done in 2 different days: firstly on the right lung and secondly on the left one, with a total of 2.5 L saline in every lung. The procedure was well tolerated with a good clinical response, and the girl was discharged 2 weeks later. Conclusions: We found a solution to a challenging situation which is to perform a whole-
lung lavagein a toddler by placing concurrently 2 tubes into the airway. We believe it is possible to perform a whole-
lung lavagein small children despite not having specific
double-lumen tubesfor children aged below 8 years.
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