BACKGROUD: Pulmonary alveolar proteinosis is a rare disorder that is characterized by a large accumulation of lipoproteinaceous material within the alveoli. This causes respiratory failure due to a restriction of gas exchange and changes in the ventilation/perfusion ratio. Clinical symptoms are variable and depend on the severity of damage of the lung parenchyma. Treatment method is whole-lung lavage, where the accumulated lipoproteinaceous material is removed using large quantities of saline. CASE PRESENTATION: This case report describes a 45 year old patient with advanced pulmonary alveolar proteinosis. Due to the presence of severe global respiratory insufficiency, this patient could not undergo the classic whole-lung lavage using a double-lumen tube and selective lung ventilation. The whole-lung lavage was performed with the support of veno-venous extracorporeal membrane oxygenation. A total of 27 l of warm saline was used. CONCLUSION: According to the current published literature, whole-lung lavage with extra-corporeal membrane oxygenation support is a very rare treatment method. Even when taking into account all of the risks associated with whole-lung lavage and v-v extracorporeal membrane oxygenation support, we found that this technique is very effective and, without a doubt, it saved the life of our patient.

Department of Anaesthesiology and ICM 2nd Faculty of Medicine Charles University Prague Prague 5 Úvalu 84 150 06 Praha 5 Czech Republic Department of Anaesthesiology and ICM 2nd Faculty of Medicine Motol University Hospital Prague 5 Úvalu 84 150 06 Praha 5 Czech Republic

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University Prague Prague 5 Úvalu 84 150 06 Praha 5 Czech Republic

Pneumology Department 2nd Faculty of Medicine Charles University Prague Prague 5 Úvalu 84 150 06 Praha 5 Czech Republic

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