Published online Jul 31, 2019. doi: 10.5492/wjccm.v8.i4.49
Peer-review started: March 15, 2019
First decision: June 6, 2019
Revised: June 21, 2019
Accepted: July 17, 2019
Article in press: July 17, 2019
Published online: July 31, 2019
Independent lung ventilation, though infrequently used in the critical care setting, has been reported as a rescue strategy for patients in respiratory failure resulting from severe unilateral lung pathology. This involves isolating and ventilating the right and left lung differently, using separate ventilators. Here, we describe our experience with independent lung ventilation in a patient with unilateral diffuse alveolar hemorrhage, who presented with severe hypoxemic respiratory failure despite maximal ventilatory support. Conventional ventilation in this scenario leads to preferential distribution of tidal volume to the non-diseased lung causing over distension and inadvertent volume trauma. Since each lung has a different compliance and respiratory mechanics, instituting separate ventilation strategies to each lung could potentially minimize lung injury. Based on review of literature, we provide a detailed description of indications and procedures for establishing independent lung ventilation, and also provide an algorithm for management and weaning a patient from independent lung ventilation.
Core tip: Severe unilateral lung disease presents a unique scenario where the diseased lung has very poor compliance, while the non-diseased lung remains normally compliant. In these patients, conventional positive pressure ventilation causes preferential distribution of tidal volume to the non-diseased lung causing its overdistension and inadvertent volutrauma. Placement of a double lumen endotracheal tube and providing independent lung ventilation, with a ventilator for each lung, can potentially minimize lung injury. This will allow institution of lung protective ventilation strategies to each lung, individualized based on their respective compliances.