[Superimposed high-frequency jet ventilation induced deterioration of oxygenation during whole lung lavage in a patient with pulmonary alveolar proteinosis].

A 39-year-old man suffering from pulmonary alveolar proteinosis underwent whole lung lavage of the right lung under one-lung ventilation with total intravenous anesthesia in the right lateral position. Superimposed high-frequency jet ventilation (SHFJV) was applied for approximately 10 minutes during lung lavage. The settings of HFJV were as follows: FIO2 = 1.0, rate = 150 bpm, driving pressure = 1 atm, inspiratory time = 30% of cycle. Since peak inspiratory pressure was high (29 cm H2O) during intermittent positive pressure ventilation (IPPV) due to severe bridle ventilation impairment, HFJV was performed only in the exhalation phase of IPPV. SpO2 and PaO2 at the time of unilateral lung filling declined following initiation of SHFJV, from 98% and 93 mmHg to 95% and 62 mmHg, respectively. Although pulmonary arterial pressure tended to be slightly elevated, little change in blood pressure, cardiac output and central venous pressure was observed. SpO2 was quickly restored after the end of SHFJV. The reason for deterioration of oxygenation might have been an increase in shunt due to shift of pulmonary blood flow from the ventilated lung to the nonventilated lung. These findings suggest that performance of SHFJV during lung lavage for a patient with advanced pulmonary alveolar proteinosis may cause pulmonary oxygenation capacity to deteriorate even when circulatory inhibition is minimal.