Breathing new life: Cutting-edge anesthetic strategies for whole lung lavage in pulmonary alveolar proteinosis

Pulmonary Alveolar Proteinosis (PAP) is a rare condition where surfactant accumulates in the lungs' alveoli, causing respiratory failure. Whole lung lavage (WLL) is the primary treatment, requiring careful perioperative management due to potential complications. We present the case of a 38-year-old man with severe PAP who underwent WLL with cardiopulmonary bypass standby. Preoperative assessment revealed severe hypoxemia and respiratory alkalosis. During surgery, he experienced desaturation and hemodynamic instability, necessitating noradrenaline support and real-time lung ultrasound monitoring. Postoperatively, significant improvements in oxygen levels and radiographic findings were observed. Diagnosis relies on Broncho alveolar lavage fluid analysis, and WLL is effective for patients with impaired gas exchange, improving symptoms and survival. This case highlights the importance of multidisciplinary care and meticulous perioperative management in achieving positive outcomes in PAP treatment with WLL.