Table 2. WLL protocol.

WLL

Pre-lavage

Obtain full PFT’s to determine baseline FRC and shunt fraction on FiO2 =1.0

Determine lung with greater involvement through imaging and V/Q scan

Estimate the FRC of the lung to be treated

Prepare 50 L of saline (in 3 L bags) warmed to 37 °C

Suspend saline reservoir 50 cm above carina

Get a vest for chest physiotherapy

Get a Y adaptor

Position patient in the supine position

Intubation and lung isolation

Place the vest on patient, intubate with a left sided DLT

Perform a bronchoscopy to confirm ET tube position

Check for leak by ventilating each lung separately

Check for air leak by venting the non-ventilated lung into a saline water seal cup while the ventilated lung is held at a plateau pressure of 50 cm H2O

Lung lavage

Most severely affected lung is lavaged initially

Denitrogenation: ventilate both lungs with FiO2 of 1.0 for 15 minutes

Degassing: slow filling of the treatment lung at a rate that does not exceed 125 mL/min (versus active suction of the lung to be treated followed by airway occlusion for 10–15 minutes)

Allow saline to flow under gravity into the lung, up to the estimated FRC volume of that lung

Repeat cycles of tidal volume filling of 500–1,000 cc of warmed saline followed by chest percussion therapy for 2 minutes with subsequent passive drainage of the fluid thereafter

Continuously monitor lavage input and output: large loss of fluid of more than 1,000 cc may indicate leakage into contralateral lung or the pleural space

Continue lavage until the returned fluid is clear

Actively suction remaining fluid from the lung

Ventilate both lungs

Consider extubation or re-intubation with a single lumen ET tube if hypoxemic

Obtain CXR post procedure

WLL, whole lung lavage; DLT, double lumen endotracheal tube; FRC, functional residual capacity.