Letters to the Editor
Protocols for bronchopulmonary lavage call for warmed solution (1–3). It is often not possible, however, to obtain large quantities of reliably warmed solution on short notice.
We recently performed a bilateral, sequential, lung lavage on a 48-yr-old man with pulmonary alveolar proteinosis. All of the lavage fluid was warmed by using a SIMS Level 1® (Rockland, MA) fluid warmer. In addition, lower body forced-air warming was used, and the temperature was measured by using an esophageal probe. The upper abdomen, thorax, and head were left exposed to permit chest physical therapy and to allow for observation of the double-lumen tube. The right lung was lavaged with 11 L and the left lung with 12 L. There were 17 lavages averaging 1300 mL infused over an average of 8 min. The entire anesthetic duration was 7 h. The initial esophageal temperature was 36.5°C and increased steadily to 37.5°C. Lavage fluid just before installation in the double-lumen tube measured 36.5°C.
We recommend these high-performance warmers for lung lavage fluids. They assure reliably warmed fluid. No advance planning is needed to warm large quantities of fluid. In addition, the delivery of excessively hot fluids (because of improper prewarming) is avoided.
Dennis R. Valade CRNA *
Michael S. Stix MD, PhD *
Anthony W. Gray Jr. MD †
1. Murray MJ, De Ruyter ML, Harrison BA. Bilateral lung washings for pulmonary alveolar proteinosis. J Bronchol 1998; 5:324–6.
2. Walsh FW, Rumbak MJ. The technique of whole lung lavage. J Crit Illness 1996; 11:191–7.
3. Benumof JL. Anesthesia for thoracic surgery. 2nd ed. Philadelphia: WB Saunders, 1995.