Pulmonary alveolar proteinosis is a rare disease of unknown etiology characterized by the accumulation of surfactant like phospholipids and proteinaceous material in the alveolar space. The removal of lipoproteinaceous material from the alveolar can be the only means of effectively treating the progressive hypoxemia in pulmonary alveolar proteinosis. The current technique of the lavage follows: The procedure can be accomplished by the use of Carlens tube, with lavaging of one lung while the other is ventilated, the ventilated lung is lavaged in a similar manner two or three days later. In this case, we performed sequential bilateral pulmonary lavage. We report a case of broncho-pulmonary lavage in which changes of oxygenation and hemodynamics were observed. We conclude that the procedure can be performed by careful monitoring such as continuous monitoring of S v O2, SpO2, effective static comliance.