Bilateral bronchoalveolar lavage: a clinical case, method and discussion

Bronchoalveolar lavage is the most effective treatment of alveolar proteinosis. We describe a variant of the usual technique. In a clinical case, we performed bronchoalveolar lavage sequentially in both lungs, without needing to stop the technique after completing the lavage of the first lung, with significant clinical improvement of the patient (pulmonary compliance and saturation). Given the amount of protein-like material lavaged, it was more effective and better tolerated in prone decubitus position. This variant permitted a shorter hospital stay. It avoided new sedation and intubation. The patient could be extubated at a few hours with good clinical tolerance. Lavage of both lungs permitted discharge to ward in less than 24 hours. The result at middle term was similar to the conventional technique. Lavage could be performed again on several occasions with the same clinical tolerance.