Fatma ULUS, Behiye AKKALYONCU, Belgin SAMURKAŞOĞLU, Hilal Günal SAZAK, Polat PEHLİVANOĞLU, Mehtap TUNÇ, Özlem ÇAKIR, Şaziye ŞAHİN

An uncommon procedure for a rare ailment: Massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis

Nadir bir işlem olan masif bronkoalveolar lavaj (MBAL) genel anestezi ve tek akciğer ventilasyonu (TAV) gerektiren geniş hacimli lavajdır. MBAL sırasında, bir akciğere, çift lümenli tüpün bir lümeni aracılığıyla, izotonik salin infüze edilip drene edilir. MBAL, semptomatik pulmoner alveolar proteinosis (PAP) için en etkin tedavi yöntemidir. PAP tanısı olan 27 yaşında erkek hastaya terapötik MBAL planlandı. Standart preoksijenasyon, monitörizasyon ve anestezi indüksiyonunu takiben çift lümenli tüp yerleştirildi. Tüp pozisyonu fiberoptik bronkoskopla doğrulandı. İnternal juguler ven, radiyal ve pulmoner arter kateterizasyonu uygulandı. Özafageal ısı probu ve foley sonda yerleştirildi. Her seansta ventile olmayan akciğer 1000 ml serum fizyolojik ile doldurulup, serbest direnajla boşaltıldı. Sol ve sağ akciğer 2 hafta arayla yıkandı. Sıvı retansiyonu olmayan her bir MBAL sırasında toplam 20 L serum fizyolojik kullanıldı. Yıkama sıvısı berrak geldiğinde işlem sonlandırıldı. Sol ve sağ MBAL süreleri sırasıyla 325 ve 275 dk idi. TAV sırasında arteriyel oksijenasyon, artmış şanta rağmen, kabul edilebilir sınırlarda idi. Her bir işlem sonunda, hasta ameliyathanede ekstübe edilerek, sorunsuz olarak yoğun bakım ünitesine transfer edildi. Hastanın kliniği ve laboratuvar bulgularında belirgin düzelme gözlendi. Sonuç olarak, MBAL uzun süresine ve risklerine rağmen, uygun koşullar sağlandığında güvenli ve yararlıdır.

Nadir görülen bir hastalık için nadir bir girişim: Bir pulmoner alveolar proteinosis hastasında masif bronkoalveolar lavaj

As a rare procedure, massive bronchoalveolar lavage (MBAL) is a large-volume lavage which necessitates general anesthesia and one-lung ventilation (OLV). During MBAL isotonic saline is instilled into one lung and drained through one lumen of a double-lumen tube. MBAL is the most effective treatment for symptomatic pulmonary alveolar proteinosis (PAP). A 27-year-old male with PAP was scheduled for therapeutic MBALs. After standard preoxygenation, monitoring and anesthesia induction, a double-lumen tube was placed. Tube position was verified by a fiberoptic bronchoscope. The internal jugular vein, radial and pulmonary arteries were cannulated. A temperature probe and foley catheter were inserted. The nonventilated lung was filled with 1000 mL saline and then drained in each session. The left and right lung were lavaged with an interval of 2 weeks. A total of 20 L saline was used in each MBAL without retention. MBALs were terminated after the effluent became clear. Duration of the left and right MBALs were 325 and 275 minutes, respectively. Despite increased shunt fraction, oxygenation was within acceptable limits during OLV. The trachea was extubated in the operating room uneventfully after each MBAL. The patient’s clinical and laboratory findings were evidently improved. Consequently, if proper conditions are provided, MBAL is safe and beneficial despite its risks and the long duration.

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