Whole Lung Lavage in Autoimmune Pulmonary Alveolar Proteinosis: Unique Challenges in a Resource-Limited Setting

Autoimmune pulmonary alveolar proteinosis (PAP) is characterized by antibodies to granulocyte-macrophage colony-stimulating factor (GM-CSF), alveolar macrophage dysfunction, and surfactant accumulation. Whole lung lavage (WLL) is the treatment of choice in patients with PAP and severe hypoxemia. In resource-limited settings, WLL can be performed in the intubated, anesthetized patient who is being one lung ventilated using a Y-type bladder irrigation catheter for saline instillation and drainage.