A novel, rapid, and effective cardiopulmonary bypass-based technique for whole lung lavage in pulmonary alveolar proteinosis and silicosis.

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Background: Pulmonary alveolar proteinosis (PAP) is a rare and severe disorder treated with whole lung lavage (WLL). Traditional WLL techniques are time-intensive and vary widely, lacking standardisation. This study introduces an innovative WLL method using a cardiopulmonary bypass (CPB) system to improve efficiency, reduce procedural time, and maintain safety. Aims and Objectives: To evaluate the feasibility, safety, and outcomes of a CPB-based WLL technique for patients with PAP and silicosis at a tertiary referral centre. Methods: A retrospective analysis of 33 WLL procedures performed between 2010 and 2024 on patients aged ≥18 years was conducted. The CPB system delivered warmed saline at 1.5L/min for PAP and 0.75L/min for silicosis. This technique allowed continuous flow infusion and enhanced clearance of lung contents. Outcomes included procedural duration, oxygenation improvement, and complication rates. Results: The innovative CPB-based WLL achieved a median procedural time of 65 minutes [58.5, 67.5], significantly shorter than reported durations of 120 to 360 minutes for traditional methods. Nearly half of the patients required no additional WLL. Improvements in oxygen saturation and six-minute walk distance post-procedure were observed, with median hospital stays of 2 days [2, 3]. No infectious or mechanical complications were reported. Conclusions: The CPB-based WLL technique offers significant advantages over traditional methods, including reduced procedural time and enhanced efficiency, without compromising safety. These findings support its potential for broader adoption and further refinement through prospective studies.

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