Independent lung ventilation in the intensive care unit: desperate measure or viable treatment option?

Independent lung ventilation is often used intra-operatively but has also been used in intensive care in a variety of clinical situations. Ventilating lungs independently of each other may be life-saving when a lung abnormality is predominantly unilateral. We successfully used independent lung ventilation in two patients, who benefited from anatomical and physiological separation of their lungs. These cases remind intensivists that independent lung ventilation is a viable option to be considered in cases of pulmonary abnormality when conventional mechanical ventilation is deleterious.

[1]  Arthur S Slutsky,et al.  A computed tomography scan assessment of regional lung volume in acute lung injury. The CT Scan ARDS Study Group. , 1998, American journal of respiratory and critical care medicine.

[2]  F. Jardin,et al.  Pressure-volume curves in acute respiratory distress syndrome: clinical demonstration of the influence of expiratory flow limitation on the initial slope. , 2002, American journal of respiratory and critical care medicine.

[3]  K. Hillman,et al.  Asynchronous independent lung ventilation (AILV). , 1980, Critical care medicine.

[4]  D. Ingbar,et al.  Massive Hemoptysis: Pathogenesis and Management , 1988 .

[5]  P. Papadakos,et al.  Pressure-controlled inverse-ratio synchronised independent lung ventilation for a blast wound to the chest. , 1991, Clinical intensive care : international journal of critical & coronary care medicine.

[6]  W. Hurford,et al.  A quality improvement study of the placement and complications of double-lumen endobronchial tubes. , 1993, Journal of cardiothoracic and vascular anesthesia.

[7]  J. J. Steinberg,et al.  Bronchial rupture, a complication of use of the Robertshaw double-lumen tube. , 1979, Anesthesiology.

[8]  D. Dreyfuss,et al.  Ventilator-induced lung injury: lessons from experimental studies. , 1998, American journal of respiratory and critical care medicine.

[9]  M. V. Van Dyck,et al.  Kinking of a right-sided double-lumen tube in the right upper lobe bronchus. , 1994, Anesthesiology.

[10]  L. Puybasset,et al.  Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure , 2000, Intensive Care Medicine.

[11]  S. Sahn,et al.  Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. , 1990, Chest.

[12]  Steffen Leonhardt,et al.  Assessment of regional lung recruitment and derecruitment during a PEEP trial based on electrical impedance tomography , 2008, Intensive Care Medicine.

[13]  R. Rogers,et al.  Update on the clinical diagnosis, management, and pathogenesis of pulmonary alveolar proteinosis (phospholipidosis). , 1984, Chest.

[14]  P. Zannini,et al.  Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema. , 1993, Chest.

[15]  K. Hillman,et al.  Management of massive air leak with asynchronous independent lung ventilation , 2005, Intensive Care Medicine.

[16]  A. Shohtsu,et al.  New device for one-lung anesthesia: endotracheal tube with movable blocker. , 1982, The Journal of thoracic and cardiovascular surgery.

[17]  C. Carvalho,et al.  Management of bronchopleural fistula with a variable-resistance valve and a single ventilator. , 1997, Chest.

[18]  Q. Lu,et al.  Incidence and regional distribution of lung overinflation during mechanical ventilation with positive end-expiratory pressure* , 2004, Critical care medicine.

[19]  Doyle Dj.  Bronchial blockade to improve alveolar ventilation , 1993 .

[20]  R. Giuliani,et al.  Independent lung ventilation in patients with unilateral pulmonary contusion. Monitoring with compliance and EtCO2 , 2001, Intensive Care Medicine.

[21]  A. Mortimer,et al.  Unilateral high frequency jet ventilation , 2004, Intensive Care Medicine.

[22]  A. Torresin,et al.  Relationships Between Lung Computed Tomographic Density, Gas Exchange, and PEEP in Acute Respiratory Failure , 1988, Anesthesiology.

[23]  M. Noppen,et al.  Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. , 2005, Chest.

[24]  L. Brown,et al.  A 47-year-old woman with wheezing and respiratory failure unresponsive to conventional ventilatory modalities. , 2002, Chest.

[25]  D. Anantham,et al.  Clinical review: Independent lung ventilation in critical care , 2005, Critical care.

[26]  D. Dreyfuss,et al.  Hyperinflation-induced lung injury during alveolar flooding in rats: effect of perfluorocarbon instillation. , 1999, American journal of respiratory and critical care medicine.

[27]  H. Arendrup,et al.  The Copenhagen National Lung Transplant Group: survival after single lung, double lung, and heart-lung transplantation. , 2005, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[28]  L. Puybasset,et al.  Acute respiratory distress syndrome: Lessons from computed tomography of the whole lung , 2003, Critical care medicine.

[29]  D. Ost,et al.  Independent lung ventilation. , 1996, Clinics in chest medicine.

[30]  Harki Tanaka,et al.  Imbalances in regional lung ventilation: a validation study on electrical impedance tomography. , 2004, American journal of respiratory and critical care medicine.