Lung-Washing Approach Rescues Patient from Severe Hypoxaemia, Case Report

These findings of the case report are published in the Indian Journal of Anaesthesia in July 2026 by Dr. Ashish Khanna and Nishant Chaudhary from the Department of Anaesthesia at Medanta Hospital in Lucknow, Uttar Pradesh, India.

Addressing patients who present with a critical partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) ratio of less than 150 represents a monumental anesthetic challenge in modern clinical practice. The specific medical case is exceptionally impactful because it meticulously outlines safe ventilatory parameters, essential arterial blood gas (ABG) trends, and strategic decision points for severe hypoxemia. Consequently, it empowers medical practitioners to adopt a safer, staged protocol when simultaneous bilateral lavage poses an unacceptably high mortality risk.

A 51-year-old female presenting with progressive exertional dyspnea and severe hypoxemia underwent diagnostic imaging showing a crazy-paving pattern and bronchoscopy revealing periodic acid-Schiff-positive fluid, which confirmed a diagnosis of autoimmune pulmonary alveolar proteinosis. She was subsequently treated with a staged sequential bilateral whole lung lavage separated by three days under general anesthesia, which led to a remarkable respiratory recovery and allowed for an asymptomatic discharge on room air by the seventh day.

The fundamental pathophysiology of this rare respiratory disease centers on the abnormal accumulation of alveolar surfactant, a direct consequence of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies impairing normal macrophage clearance mechanisms. The therapeutic lavage mechanically reverses this life-threatening barrier to gas exchange by instilling and draining massive volumes of warmed saline, thereby physically extracting the suffocating lipoproteinaceous material directly from the alveolar spaces.

For contemporary critical care practitioners, the structured approach highlights the absolute necessity of strict lung-protective one-lung ventilation (OLV), continuous hemodynamic monitoring, and the strategic application of continuous positive airway pressure (CPAP) to the non-ventilated lung during desaturation events. Furthermore, it substantially enriches our current clinical understanding by proving that preserving one fully functional lung during staged interventions drastically minimizes procedural complications, thereby establishing a remarkably safer blueprint for future severe patient management.

Reference

Khanna A, Chaudhary N. Staged whole lung lavage in severe pulmonary alveolar proteinosis—Anaesthetic strategies for one-lung ventilation: A case report. Indian J Anaesth 2026;70:865-8.