INDEPENDENT LUNG VENTILATION
Section snippets
TECHNIQUES OF LUNG SEPARATION
When considering patients for independent lung ventilation, it is important to be aware of the different methods available to facilitate functional separation of the lungs. A variety of techniques have been described. These include bronchial blockers, the univent tube, coaxial tubes, and DLTs. Of these, the Fogarty balloon catheter and the DLTs are used most commonly in clinical practice.
CLINICAL CONSIDERATIONS
From the previous discussion, it is apparent that independent lung ventilation can be a technically difficult procedure with many potential complications. Nonetheless, independent lung ventilation is used routinely with success in the operating room. Its role in the ICU setting is less well defined. Although there are a variety of anecdotal reports, there are no controlled trials of independent lung ventilation in the ICU. As such, there are no strict criteria to define patients who might
SUMMARY
Situations in which independent lung ventilation may be of use include massive hemoptysis, pulmonary alveolar proteinosis, risk of interbronchial aspiration, unilateral lung injury, single lung transplant, and EPE. Any decision to attempt independent lung ventilation should take into consideration the many technical difficulties associated with the procedure. They include difficulties in the placement of DLTs and monitoring tube position, the risk of tube displacement, and the risk of airway
References (57)
Differential lung ventilation: Applications beyond the operating room.]
Thorac Cardiovasc Surg
(1993)- et al.
Continuous spirometry for detection of double-lumen endobronchial tube displacement
Br J Anaesth
(1993) - et al.
Medical management and therapy of bronchopleura] fistulas in the mechanically ventilated patient
Chest
(1990) - et al.
Balloon method for detecting inadequate double-lumen tube cuff seal
Ann Thorac Surg
(1993) - et al.
Advantages of a new polyvinyl chloride double-lumen tube in thoracic surgery
Ann Thorac Surg
(1983) - et al.
The relationship between peak inspriatory pressure and positive end-expiratory pressure on the volume of air lost through a bronchopleural fistula
J Pediatr Surg
(1980) Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema
Chest
(1993)- et al.
New device for one-lung anesthesia: Endotracheal tube with moveable blocker
Thorac Cardiovasc Surg
(1982) - et al.
Bronchopleural fistula - present-day study of an old problem
Ann Thorac Surg
(1971) - et al.
Right upper lobe obstruction with right-sided double-lumen endobronchial tubes: A comparison of two types
Cardiothorac Vasc Anesth
(1988)
Differential mechanical ventilation in respiratory failure due to severe unilateral lng disease
Mayo Clin Proc
Unilateral auto-PEEP in the recipient of a single lung transplant
Chest
The performance of four pleural drainage systems in an animal model of bronchopleural fistula
Chest
Plastic endobronchial tubes in the management of life-threating hemoptysis
Chest
Placement of double-lumen endobronchial tubes
Br J Anaesth
Endoscopic gluing of bronchopleural fistulas
Ann Thorac Surg
Double-lumen endobronchial tube intubation using a retrograde wire technique
Anesth AnaIg
Reliability of auscultation in positioning double-lumen endotracheal tubes
Can T Anaesth
Torsion of a double-lumen tube in the left bronchus
Anesthesiology
Critical factors in determining adequate pleural drainage in both the operated and nonoperated chest
Am Surg
Obstruction of a double-lumen endotracheal tube bv a saber-sheath trachea
Anesth Analg
Intraoperative dual-mode independent lung ventilation of a patient with bronchopleural fistula
Anesth Analg
Margin of safety in positioning modem double-lumen endotracheal tubes
Anesthesiology
Complications of double-lumen tracheal tubes. In
Bilateral upper lobe obstruction from a single double-lumen tube
Anesthesiology
Bronchial cuff pressures of double-lumen tubes
Anesth Analg
Depth of placement of left double-lumen endobronchial tubes
Anesth Analg
Manufacturing defect in a double-lumen tube
Anesth Analg
Cited by (27)
Intelligent decision support for lung ventilation
2020, Control Applications for Biomedical Engineering SystemsBronchopleural fistula: An update for intensivists
2010, Journal of Critical CareCitation Excerpt :Independent lung ventilation (ILV), a commonly used technique in anesthesia for thoracic surgery, may be used in intensive care patients as an alternative to conventional ventilation in special situations. When a lung injury is predominantly unilateral, ventilating both lungs as a single unit may potentiate volutrauma and barotrauma to the normal lung and worsen the intrapulmonary shunting in the diseased lung because there is heterogeneous distribution of ventilation and PEEP [38]. In the setting of a BPF, ILV facilitates optimal ventilation of the normal or less diseased lung, while allowing the maintenance of lower airway pressures on the affected side reducing the air leak.
Independent lung ventilation in the postoperative management of large bronchopleural fistula
2010, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Chest tubes allow a continuous leak of air from the tracheal tree to the external world (Figure 2, A), resulting in loss of airway pressure and progressive alveolar collapse bilaterally. Increasing airway pressure only worsens the magnitude of the fistula.1-4 Physiologic separation of the lungs by means of ILV can be life-saving in this situation.5
Independent Lung Ventilation and Bronchopleural Fistula
2008, Mechanical Ventilation: Clinical Applications and PathophysiologyMechanical Ventilation Strategies in Massive Chest Trauma
2007, Critical Care ClinicsCitation Excerpt :When site of bleeding is unknown, DL-ETT should be used instead of bronchial blockers. DL-ETT intubation may be difficult in the setting of massive bleeding, but it will permit bronchial toilet and limited bronchoscopic therapy [24]. After the bleeding is isolated and contained, any necessary definitive treatment should be sought expeditiously [49].