Anesthetic techniques to facilitate lung lavage for pulmonary alveolar proteinosis in children—new airway techniques and a review of the literature

Wilson, Caroline A.; Wilmshurst, Sally; Black, Ann E.

doi:10.1111/pan.12626

Cited by 23 publications

(23 citation statements)

References 16 publications

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“…The smallest double-lumen ETT is 26 French (∼8.7 mm). In infants and small children, different techniques have been proposed [8]: WLL through an elongated cuffed ETT [7] or through a balloon catheter [8,9]; use of two ETTs: a bronchial tube for the lavage and a tracheal tube for ventilation [8,10,11]; WLL via the channel of a flexible bronchoscope with an external diameter of 2.8, 3.5 or 4.9 mm, according to the age of the patient, which allows direct visualisation and more selective lobar lavages (two techniques have been used, one with the bronchoscope being pushed down alongside a narrow ETT, or with it inserted in a large ETT [12][13][14]); and in severely ill children, WLL has been performed under extracorporeal membrane oxygenation [15] or liquid ventilation using polyurethane perflubron [16].…”

Section: Resultsmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.

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Section: Resultsmentioning

confidence: 99%

ERS statement: interventional bronchoscopy in children

et al. 2017

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“…Furthermore, we assume that our method may probably be useful in patients with uneven distribution of ground glass opacities. We are also looking forward to incorporating our method into pediatrics, as our noninvasive approach may be beneficial in patients requiring frequently repeated procedures (25), or when double lumen cuffed intubation is difficult (26).…”

Section: Discussionmentioning

confidence: 99%

Novel method of noninvasive ventilation supported therapeutic lavage in pulmonary alveolar proteinosis proves to relieve dyspnea, normalize pulmonary function test results and recover exercise capacity: a short communication

et al. 2018

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Whole lung lavage (WLL) under general anesthesia with a double-lumen endobronchial intubation has remained standard treatment option for pulmonary alveolar proteinosis (PAP) for over fifty years now. To the best of our knowledge, this is the first description of noninvasive ventilation (NIV) as an innovative alternative, which enables safe and effective treatment. NIV support enabled cost-effective lavage of the most affected segments and resulted in restoration and long-term maintenance of exercise capacity and diffusion, without WLL related hypoxaemia, volume overload, intubation, or mechanical ventilation related complications. The study presents all details of performed procedure, including anesthesia, NIV technique and bronchoscopy, therefore this may be easily implemented into clinical practice at other centers conducting PAP treatment. We assume that presented technique of therapeutic lung lavage (TLL) with NIV support may be considered a novel PAP treatment method, however, target population who will benefit the most from such therapy modification must be assessed in large scale prospective trials. (2). This method provides long-lasting beneficial effects. It is usually performed unilaterally, with the patient in a supine position. The lavaged lung is filled up to functional residual capacity (FRC), and cycles of saline instillation and subsequent drainage are repeated, until clear effluent is obtained. Taking into account WLL methodology, it facilitates severe hypoxemia by elicitation of extensive V/Q mismatch due to shunt through the treated lung and respiration conducted by the contralateral lung, which interstitial tissue is often heavily affected by present disease. This mechanism sometimes creates a need for extracorporeal membrane oxygenation ECMO support (3). Moreover, uneven alveolar distribution in the lavaged lung may promote post procedure pulmonary edema which is probably responsible for the demand for prolonged ventilation and oxygen supplementation (4,5). Obviously, due to low incidence of the disease, no gold standard WLL protocols have been developed as yet.The major indications for WLL in centers caring for PAP patients worldwide include radiographic progression, lung function deterioration and hypoxemia (4).WLL, although considered as reasonably safe and efficient if performed in well-experienced specialized centers, has serious limitations, which include post procedure complications, the most common being fever, hypoxemia, wheezing, pneumonia and saline leakage due to malposition of the endotracheal tube (4,6). Also pneumothorax, pleural effusion, cardiac arrest (4) and one case of WLL-associated death (7) were reported. There is a possibility that mortality rate is under reported.Hypoxemia usually occurs during the drainage phase, because blood is again redirected from the ventilated lung to the contralateral lavaged one and a decrease in airway pressure occurs, leading to perfusion of the lung undergoing BAL and thus a fall in partial oxygen pressure PaO 2 (4).Last but no...

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“…Lung lavage requires lung isolation to allow simultaneous lavage of one lung and ventilation of the other. Techniques for lung lavage in children are not standardised, all having their own disadvantages and limitations (1). In this case report, we describe a unilateral lung lavage technique in a child with PAP, which has not previously been reported and that may be applicable to other paediatric patients with PAP.…”

Section: Introductionmentioning

confidence: 88%

“…Although some authors reported that they have successfully manipulated lung isolation by placing two cuffed ETTs in each bronchus (5) or by selectively ventilating the non-lavaged lung with a cuffed ETT (6), many others stated that these techniques resulted in intraoperative hypoxemia (1). Furthermore, placing two tubes was not practical and might injure laryngeal structures.…”

Section: Discussionmentioning

confidence: 99%