INTRODUCTION: Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the alveolar accumulation of surfactant. The gold standard therapy is whole lung lavage (WLL), although it is not a standardized procedure.

METHODS: Retrospective study of patients who underwent WLL, in a center of Brazil, analyzing the current practice regarding the procedure. Data were collected from patient medical records.

RESULTS: A total of 33 WLL from 12 patients were evaluated. Among patients, the mean age was 41.9 years (21.0-61.0) and 66.7% were female. Twenty-five WLL (75%) were conducted in the operation room, 32 of which (97%) were one-sided procedures. The WLL were performed with warm saline (35°C) through a double-lumen endobronchial tube, with the patient mainly in the supine position (72.7%). The mean time between diagnosis and the first WLL was 2±2.9 years, and the median of time separating WLL therapy for each lung was 106.5 days (21,5-247,3; CI 95%). Mean of procedures per patient were 2.8±1.9 (CI 95%), and, complication rate was 24,2%. Through a univariate analysis, the mean instilled volume utilized in the group presented with complications was 23.4±7.8 liters, while those without complications were 17.7±7.6L (OR 1; CI 95%; p=0.085). Multivariate analysis did not reveal a significant risk factor for complications. Mortality within 30 days was 8.3%. There was a significant improvement in the mMRC scale after the intervention (p < 0.001).

CONCLUSIONS: Although WLL is an invasive procedure with an important rate of complications, it is the optimal treatment for PAP and provides improvements for affected patients. There is a need for standardizing the practice of WLL to improve its quality and safety.