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Could bronchial washing (as used in pulmonary alveolar proteinosis and some forms of pneumonia) be used to treat or at least reduce the length of time a patient suffering from COVID-19 required mechanical respiration?

In addition to alleviating the pneumonia symptoms perhaps the saline flushing solution could be formulated with some type of soaping agent that was still compatible with the respiratory tract since the virus has been shown to be susceptible.

Assuming the procedure could be run continuous on each bronchus for the duration of the virus life cycle (how long is this?) then you could destroy all traces of the virus (unless it remained dormant within a host cell).

Youtube video showing procedure

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  • An oxygen enriched fluid as used in liquid breathing (en.wikipedia.org/wiki/Liquid_breathing) could be used to extend the duration of the procedure and also do both bronchiole at the same time.
    – norlesh
    Mar 30, 2020 at 9:44

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The current guidelines for treatment of Adult Respiratory Distress Syndrome do not recommend such treatment.

In SARDS associated with covid-19 disease there is alveolar collapse due to infection and death of the surfactant making pneumocytes lining the alveoli. the recommendation is to generally run these patients on the dry side while being ventilated as there is a tendency to fluid overload the lungs. Adding fluid with pulmonary irrigation sounds counterproductive and is not going to correct the underlying issue of a lack of surfactant.

https://bmjopenrespres.bmj.com/content/6/1/e000420.full Guidelines on the management of acute respiratory distress syndrome

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  • I realize it is not part of treatment guidelines, my question was as to whether it could work - the premise is that the procedure would flush all of the detritus from inside the avioli, alleviating the underlying cause for the fluid buildup that is diluting the surfactant still being produced by the remaining Type II avioli cells that haven't yet been attacked.
    – norlesh
    Mar 30, 2020 at 12:25
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    I can only imagine it worsening the situation adding more fluid to the lungs like that. Maybe there's an animal model you could look at
    – Graham Chiu
    Mar 30, 2020 at 15:31
  • One reason why it is not recommended in ARDS is because it damages surfactant and compliance. IMO it is doubtful that it would help in COVID-19 ARDS.
    – Thomas
    Apr 29, 2020 at 17:45

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