{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:44:25Z","timestamp":1789688665032,"version":"4.0.1"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Pulmonary alveolar proteinosis causes severe hypoxaemia. Whole lung lavage is standard therapy, but anaesthetic management of staged sequential bilateral lavage in patients with partial pressure of oxygen (PaO\n 2<\/jats:sub>\n )\/fraction of inspired oxygen (FiO\n 2<\/jats:sub>\n ) <150 is challenging. We describe a 51-year-old female with autoimmune pulmonary alveolar proteinosis and respiratory failure who underwent staged lavage 3 days apart under general anaesthesia. A 35-Fr left-sided double-lumen tube (DLT) was placed with fibreoptic confirmation. Lung-protective one-lung ventilation was used with a tidal volume of 300 mL, a respiratory rate of 18\/min, a positive end expiratory pressure of 6\u20138 cmH\n 2<\/jats:sub>\n O and FiO\n 2<\/jats:sub>\n 1.0. 10 L saline was used in right lung lavage with 9.2 L recovered over 185 minutes. Post-lavage PaO\n 2<\/jats:sub>\n improved from 68 to 142 mmHg. 8 L saline was utilised in left lung lavage, with 7.5 L recovered over 160 minutes. Post-lavage PaO\n 2<\/jats:sub>\n was 198 mmHg. The patient was extubated on the table after both procedures and discharged on room air on day 7. Sequential lavage with meticulous DLT positioning, lung-protective ventilation, serial arterial blood gas monitoring, and multidisciplinary coordination enabled safe management.\n <\/jats:p>","DOI":"10.4103\/ija.ija_671_26","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T14:00:22Z","timestamp":1784383222000},"page":"865-868","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Staged whole lung lavage in severe pulmonary alveolar proteinosis\u2014Anaesthetic strategies for one-lung ventilation: A case report"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7845-7188","authenticated-orcid":false,"given":"Ashish","family":"Khanna","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Medanta Hospital, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2873-5117","authenticated-orcid":false,"given":"Nishant","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Medanta Hospital, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"R1-20260720","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1055\/s-0039-3402727","article-title":"Pulmonary alveolar proteinosis syndrome","volume":"41","author":"Kelly","year":"2020","journal-title":"Semin Respir Crit Care Med"},{"key":"R2-20260720","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13256-017-1218-2","article-title":"Pulmonary alveolar proteinosis and first successful whole lung lavage in Sri Lanka: A case report","volume":"11","author":"Galhenage","year":"2017","journal-title":"J Med Case 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Anesth"},{"key":"R12-20260720","doi-asserted-by":"crossref","first-page":"100233","DOI":"10.1016\/j.jcadva.2026.100233","article-title":"Anaesthetic considerations for therapeutic whole-lung lavage in acquired pulmonary alveolar silico-proteinosis: A case report","volume":"3","author":"Padala","year":"2026","journal-title":"JCA Adv"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.4103\/ija.ija_671_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:00:19Z","timestamp":1784534419000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.4103\/ija.ija_671_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":12,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_671_26","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-05-03","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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