Chest
Volume 120, Issue 3, September 2001, Pages 1024-1026
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Selected Reports
Pulmonary Alveolar Proteinosis Causing Severe Hypoxemic Respiratory Failure Treated With Sequential Whole-Lung Lavage Utilizing Venovenous Extracorporeal Membrane Oxygenation: A Case Report and Review

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Abstract

Pulmonary alveolar proteinosis is characterized by the accumulation of proteinaceous material in the alveoli leading to varying degrees of impairment in gas exchange. Generally, the degree of hypoxemia is mild, and it is rare to have respiratory failure requiring mechanical ventilation. We present a 53-year-old woman with the most severe degree of hypoxemia associated with alveolar proteinosis reported in the English-language adult literature. Her therapy of sequential whole-lung lavage performed while receiving venovenous extracorporeal membrane oxygenation in one operative session is the first reported successful use of this approach.

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Case Report

A 53-year-old woman presented to an outside hospital with progressive dyspnea, general malaise, and a decreased appetite over a duration of approximately 3 weeks. Chest radiography revealed bilateral alveolar infiltrates. ECG findings were remarkable for only sinus tachycardia. Abnormal laboratory findings at presentation included the following arterial blood gas measurements: pH, 7.5; Pco2, 30 mm Hg; Pao2, 30 mm Hg on room air; hemoglobin, 18.7 g/dL; and hematocrit, 55 %. An initial diagnosis

Discussion

In this report, we describe the most severely hypoxemic adult patient with respiratory failure secondary to pulmonary alveolar proteinosis ever reported in the literature. This also represents the first case in an adult where bilateral sequential WLL was performed under veno-venous ECMO with discontinuation of bypass prior to leaving the operating room.

The main physiologic disturbance in this disease is impairment of gas exchange secondary to filling of the alveoli with phospholipoproteinaceous

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