Safety of Bilateral Whole Lung Lavage for Pulmonary Alveolar Proteinosis: Experiences in a Multicenter Cohort.

P ulmonary alveolar proteinosis (PAP) is a rare lung disease in which surfactant accumulates in alveolar macrophages and the distal airways, resulting in impaired gas exchange.1,2 For symptomatic patients, standard treatment is whole lung lavage to restore gas exchange.1,3 This procedure is performed under general anesthesia using a double-lumen endotracheal tube with single lung-ventilation.3,4 Warmed saline is instilled in the target lung in serial aliquots until the fluid return resembles normal lavage fluid.3 Consequently, this can take hours to perform, may be associated with hypoxemia during the procedure, and has therefore traditionally been performed as a staged procedure over multiple days (ie, 1 lung per procedure).3,4 However, some institutions have adopted techniques that allow for bilateral whole lung lavage to be performed sequentially in a single procedure, although this practice remains controversial. We describe a multicenter cohort of patients with PAP treated with bilateral whole lung lavag in a single procedural setting.