To maintain good cellular oxygenation during bronchopulmonary lavage for alveolar proteinosis is often a difficult problem to solve. A case is reported of alveolar proteinosis in whom four lavages were performed. Details of the technique are discussed, as are the problems with expedients used to improve PaO2. The use of a 10 cmH2O positive end-expiratory pressure was useful only during the "in-phase"; in the "out-phase", it worsened the PaO2. PaO2 during lavage in patients with alveolar proteinosis can only be improved by three ways: cancellation of the shunt during lung filling and, during the "out-phase", an increase in FIO2 or pulmonary artery occlusion by a balloon.
Adult Anesthesia, General