Image from CHEST 2009;136:1678-1681
Patient is intubated with a large double lumen tube; the vented lung is isolated from the lavaged lung
Large bag containing sterile warm (37degree) saline is hang on IV Pole and opened to drain by gravity into the target lung (with the drainage limb clamped).
Percussion is said to help dislodge the proteinous material from the alveoli – generally after 1L the flow slows down, the lavage limb is clamp and the drainage limb opened.
The procedure can last up to 3-4hr (we watch for hypothermia, patient hemodynamics).
The process is repeated multiple times until the collected fluid becomes clear.
Any residual fluids is aspirated from the airways with the fiberoptic bronchoscope.
We then resume ventilation to the target lung.
We carefully chart the amount of fluid that goes in and out.
A survey of current practices and procedures was published from 20 centers in 14 countries performing WLL in adults and from 10 centers in 6 countries performing WLL in children:
• Similarities: GA, double lumen, warm saline (37°C), drainage by gravity.
• Variations: Patient’s position, amount of fluid used, use of chest percussions, timing of extubation, timing of follow up.
(https://pubmed.ncbi.nlm.nih.gov/27577926/)
Setup we use:
Irrigation set from Baxter
3000cc canister from Bemis
