Effect of Whole Lung Lavage for Pulmonary Alveolar Proteinosis on Circulatory Dynamics: A Case Report

Whole lung lavage (WLL) is a standard treatment for severe pulmonary alveolar proteinosis (PAP) and is performed under general anesthesia. However, the management of anesthesia in PAP patients poses significant challenges due to their compromised respiratory function. Additionally, the instillation of large volumes of normal saline during WLL may adversely affect circulatory dynamics. In this case report, we examined the impact of WLL on circulatory parameters in a patient with severe PAP. A 71-year-old male diagnosed with idiopathic PAP underwent WLL under general anesthesia. Each lung was instilled with 1,000 mL of normal saline, followed by drainage in a series of 10 cycles per lung. Hemodynamic parameters were monitored throughout the procedure. Statistical analyses were performed to evaluate changes in circulatory values before and after saline instillation and to compare differences in hemodynamic responses between the right- and left-sided WLL. Our findings demonstrated that saline instillation during WLL significantly suppressed cardiac output. Furthermore, the suppression of circulatory function was more pronounced during right-sided WLL compared with left-sided WLL. These observations highlight the critical need for careful hemodynamic monitoring and management during WLL to ensure patient safety and optimize outcomes.