Karl Reiter1, Carola Schoen, Matthias Griese, Thomas Nicolai. 1. Kinderklinik und Kinderpoliklinik der Universitaet Muenchen am Dr. von Haunerschen Kinderspital, Muenchen, Germany. karl.reiter@med.uni-muenchen.de
Abstract
BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare alveolar filling syndrome where the mainstay of treatment is therapeutic whole-lung lavage (WLL). WLL techniques used in adults have to be modified for children because of their small-diameter airways. AIM: To describe a technique for WLL adapted for small children. METHODS: We describe a WLL technique that combines safe single-lung ventilation with the use of an age-appropriate endotracheal tube and selective occlusion of the other main bronchus with a balloon catheter through which the lavage is performed. Effectiveness measured by change in oxygen requirements and adverse effects was noted. RESULTS: We performed 64 WLL procedures in four children (age 13 months to 7 years; body weight 4.7-14 kg). Two children had idiopathic and two had secondary PAP. At referral, all children had dyspnoea at rest and required continuous oxygen supplementation. Two patients showed significantly decreased oxygen demands and radiological improvement after WLL. Two patients showed no significant response. The only adverse effect observed was transient hypoxemia. Complications comprised fluid leak at the balloon (4), balloon rupture (1), and pneumothorax (1). CONCLUSIONS: This technique for WLL combining single-lung ventilation with an endotracheal tube and lung exclusion for lavage with a balloon catheter can be safely and effectively performed in small children with PAP.
BACKGROUND:Pulmonary alveolar proteinosis (PAP) is a rare alveolar filling syndrome where the mainstay of treatment is therapeutic whole-lung lavage (WLL). WLL techniques used in adults have to be modified for children because of their small-diameter airways. AIM: To describe a technique for WLL adapted for small children. METHODS: We describe a WLL technique that combines safe single-lung ventilation with the use of an age-appropriate endotracheal tube and selective occlusion of the other main bronchus with a balloon catheter through which the lavage is performed. Effectiveness measured by change in oxygen requirements and adverse effects was noted. RESULTS: We performed 64 WLL procedures in four children (age 13 months to 7 years; body weight 4.7-14 kg). Two children had idiopathic and two had secondary PAP. At referral, all children had dyspnoea at rest and required continuous oxygen supplementation. Two patients showed significantly decreased oxygen demands and radiological improvement after WLL. Two patients showed no significant response. The only adverse effect observed was transient hypoxemia. Complications comprised fluid leak at the balloon (4), balloon rupture (1), and pneumothorax (1). CONCLUSIONS: This technique for WLL combining single-lung ventilation with an endotracheal tube and lung exclusion for lavage with a balloon catheter can be safely and effectively performed in small children with PAP.
Authors: Matthias Griese; Jan Ripper; Anke Sibbersen; Pia Lohse; Peter Lohse; Frank Brasch; Andrea Schams; Asli Pamir; Bianca Schaub; Oliver J Muensterer; Carola Schön; Judith Glöckner-Pagel; Thomas Nicolai; Karl Reiter; Andreas Hector Journal: BMC Pediatr Date: 2011-08-17 Impact factor: 2.125
Authors: Viktor Szatmári; Erik Teske; Peter G J Nikkels; Matthias Griese; Pim A de Jong; Guy Grinwis; Dirk Theegarten; Stefanie Veraa; Frank G van Steenbeek; Marjolein Drent; Francesco Bonella Journal: BMC Vet Res Date: 2015-12-09 Impact factor: 2.741