Bilateral simultaneous lung lavage utilizing membrane oxygenator for pulmonary alveolar proteinosis in an 8-month-old infant.

Pulmonary alveolar proteinosis can result in severe hypoxemia. Treatment of symptomatic patients using unilateral or lobar staged lung lavage often results in improved oxygenation and functional capacity. Lung lavage is technically difficult in infants and small children because of inability to ventilate part of the lung safely and adequately during lavage of other areas. We used extracorporeal membrane oxygenation to facilitate adequate gas exchange during lung lavage for severe respiratory failure in a 3.7 kg, 8-month-old child with pulmonary alveolar proteinosis. Oxygenation was markedly improved immediately following the procedure. Extracorporeal membrane oxygenation permits satisfactory respiratory support in the setting of severe respiratory failure and should be considered an adjunct for treatment of pulmonary alveolar proteinosis when lung lavage cannot be otherwise safely accomplished.