Role of Bronchopulmonary Lavage in the Treatment of Respiratory Failure

A Review

¹ Professor of Medicine, University of Oklahoma Medical Center, Oklahoma City
² Hospital of the University of Pennsylvania (Departments of Medicine and Physiology), Philadelphia

Bronchopulmonary lavage is a technique where-by large amounts of material can be removed from the airways and alveoli. The use of a double lumen catheter permits adequate gas exchange while one lung is being lavaged. The procedure has been performed safely even in the presence of severe hypoxemia and may have applicability to many diseases in which debridement of small airways and alveoli is desirable. Acute histologic changes and changes in compliance associated with increased surface forces are transient.

The principal indication for lavage is pulmonary alveolar proteinosis and we feel that lavage is the treatment of choice for this disease. Dramatic improvement may occur in status asthmaticus, but management is difficult and lavage should be reserved for those cases unresponsive to more conservative therapy. Insufficient data are available with respect to other diseases to draw conclusions regarding the usefulness of lavage. Preliminary observations, however, are encouraging, particularly with cystic fibrosis.