Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jul 31, 2019; 8(4): 49-58
Published online Jul 31, 2019. doi: 10.5492/wjccm.v8.i4.49
Published online Jul 31, 2019. doi: 10.5492/wjccm.v8.i4.49
Independent lung ventilation: Implementation strategies and review of literature
Sheri Berg, Edward A Bittner, Lorenzo Berra, Abraham Sonny, Division of Critical Care, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
Robert M Kacmarek, Department of Respiratory Care, Massachusetts General Hospital, Boston, MA 02114, United States
Author contributions: Berg S and Kacmarek RM performed the case and edited the manuscript; Bittner EA and Sonny A wrote and edited the manuscript; Berra L was involved in reviewing and editing the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Abraham Sonny, MD, Assistant Professor, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 444, Boston, MA 02114, United States. asonny@mgh.harvard.edu
Telephone: +1-617-7269379
Received: March 14, 2019
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
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
Core Tip
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.