RT Journal Article
SR Electronic
T1 Whole-lung lavage in a toddler. Technical challenges and solutions
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA3144
DO 10.1183/13993003.congress-2016.PA3144
VO 48
IS suppl 60
A1 Ignacio Iglesias
A1 Nuria Montferrer
A1 Rosario Nuno
A1 Silvia Gartner
A1 Ines Mir
A1 Alba Torrent
A1 Antonio Moreno
YR 2016
UL http://erj.ersjournals.com/content/48/suppl_60/PA3144.abstract
AB Introduction: Pulmonary alveolar proteinosis is a rare respiratory disease whose main treatment is the whole-lung lavage. This could be a challenging procedure in small children.Objective: The aim of this report is to show our experience coping with a 21-month-old girl with pulmonary alveolar proteinosis, who needed a whole-lung lavage due to persistent hypoxemia.Case report: Our patient was a healthy girl until she was 7 months, when she was diagnosed with myeloblastic leukemia. At the age of 13 months, a hematopoietic stem cell transplant was undergone after no response to chemotherapy.After a sepsis when she was 20 months, she had respiratory distress and hypoxemia that persisted for more than 2 weeks, so a chest CT was ordered; it showed bilateral ground-glass opacities. A bronchoalveolar lavage plus a pulmonary biopsy were undergone, confirming the diagnosis of pulmonary alveolar proteinosis.A whole-lung lavage was done, using simultaneously 2 endotracheal cuffed tubes: one (3.5 mm diameter) placed in the trachea to ventilate one lung and another of 3 mm (modified to make it longer) to instill heated saline into the bronchus to perform the lavage. This procedure was done in 2 different days: firstly on the right lung and secondly on the left one, with a total of 2.5 L saline in every lung. The procedure was well tolerated with a good clinical response, and the girl was discharged 2 weeks later.Conclusions: We found a solution to a challenging situation which is to perform a whole-lung lavage in a toddler by placing concurrently 2 tubes into the airway.We believe it is possible to perform a whole-lung lavage in small children despite not having specific double-lumen tubes for children aged below 8 years.