Skip to main content
SpringerLink
Log in

Unilateral Lung Diseases and Differential Lung Ventilation

  • Chapter
  • First Online:
Personalized Mechanical Ventilation

  • 829 Accesses

Abstract

Unilateral lung diseases are characterized by a marked asymmetry in the mechanical properties of the two lungs. Compliance of the involved lung may be increased or decreased depending on the underlying pathology. In most patients, conventional ventilatory support maintains adequate ventilation and oxygenation. When conventional ventilation is unsuccessful to maintain gas exchange, alternative methods, such as independent lung ventilation (ILV), can be considered. ILV, also known as differential lung ventilation, allows ventilating the right and left lungs separately, further improving ventilation while minimizing the risk of lung injury. No controlled trials of ILV in the critical care setting exist; therefore, no clear-cut indications have been defined for its use in patients with unilateral lung diseases. The application of ILV requires understanding the pathophysiology of the underlying process, consideration of potential complications, highly skilled nursing care, and readily available fiber-optic bronchoscopy. Although ILV is rarely required, all physicians in the critical care setting should be familiar with this modality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tuxen D. Independent lung ventilation. In: Tobin MJ, editor. Principles and practice of mechanical ventilation. New York: McGraw-Hill; 1994. p. 571–88.

    Google Scholar 

  2. Ost D, Corbridge T. Independent lung ventilation. Clin Chest Med. 1996;17:591–601.

    Article  CAS  Google Scholar 

  3. Skjeflo GW, Dybwik K. A new method of securing the airway for differential lung ventilation in intensive care. Acta Anaesthesiol Scand. 2014;58:463–7.

    Article  CAS  Google Scholar 

  4. Stow PJ, Grant I. Asynchronous independent lung ventilation. Its use in the treatment of acute unilateral lung disease. Anaesthesia. 1985;40:163–6.

    Article  CAS  Google Scholar 

  5. Shivaram U, Finch P, Nowak P. Plastic endobronchial tubes in the management of life-threatening hemoptysis. Chest. 1987;92:1108.

    Article  CAS  Google Scholar 

  6. Badesch DB, Zamora MR, Jones S, Campbell DW, Fullerton DA. Independent ventilation and ECMO for severe unilateral pulmonary edema after SLT for primary pulmonary hypertension. Chest. 1995;107:1766–70.

    Article  CAS  Google Scholar 

  7. Carvalho P, Thompson WH, Riggs R, Carvalho C, Charan N. Management of bronchopleural fistula with a variable resistance valve and a single ventilator. Chest. 1997;111:1452–4.

    Article  CAS  Google Scholar 

  8. Cinnella G, Dambrosio M, Brienza N, Bruno F, Brienza A. Compliance and capnography monitoring during independent lung ventilation: report of two cases. Anesthesiology. 2000;93:275–8.

    Article  CAS  Google Scholar 

  9. Graciano AL, Barton P, Luckett PM, Morriss F, Sommerauer JF, Toro-Figueroa LO. Feasibility of asynchronous independent lung high-frequency oscillatory ventilation in the management of acute hypoxemic respiratory failure: a case report. Crit Care Med. 2000;28:3075–7.

    Article  CAS  Google Scholar 

  10. Cinnella G, Dambrosio M, Brienza N, Giuliani R, Bruno F, Fiore T, Brienza A. Independent lung ventilation in patients with unilateral pulmonary contusion. Monitoring with compliance and EtCO(2). Intensive Care Med. 2001;27:1860–7.

    Article  CAS  Google Scholar 

  11. Pilcher DV, Auzinger GM, Mitra B, Tuxen DV, Salamonsen RF, Davies AR, Williams TJ, Snell GI. Predictors of independent lung ventilation: an analysis of 170 single-lung transplantations. J Thorac Cardiovasc Surg. 2007;133:1071–7.

    Article  Google Scholar 

  12. Rico FR, Cheng JD, Gestring ML, Piotrowski ES. Mechanical ventilation strategies in massive chest trauma. Crit Care Clin. 2007;23:299–315.

    Article  Google Scholar 

  13. Shekar K, Foot CL, Fraser JF. Independent lung ventilation in the intensive care unit: desperate measure or viable treatment option? Crit Care Resusc. 2008;10:144–8.

    Google Scholar 

  14. Fujita M, Tsuruta R, Oda Y, Kaneda K, Miyauchi T, Kasaoka S, Maekawa T. Severe legionella pneumonia successfully treated by independent lung ventilation with intrapulmonary percussive ventilation. Respirology. 2008;13:475–7.

    Article  Google Scholar 

  15. Yamakawa K, Nakamori Y, Fujimi S, Ogura H, Kuwagata Y, Shimazu T. A novel technique of differential lung ventilation in the critical care setting. BMC Res Notes. 2011;4:134.

    Article  Google Scholar 

  16. Achar SK, Chaudhuri S, Krishna H, Sagar M. Re-expansion pulmonary edema - differential lung ventilation comes to the rescue. Indian J Anaesth. 2014;58:330–3.

    Article  Google Scholar 

  17. Sarnaik A. The use of independent lung ventilation for unilateral pulmonary hemorrhage. Int J Respir Pulm Med. 2015;2:13.

    Article  Google Scholar 

  18. Minhas JS, Halligan K, Dargin JM. Independent lung ventilation in the management of ARDS and bronchopleural fistula. Heart Lung. 2016;45:258–60.

    Article  Google Scholar 

  19. Glass DD, Tonnesen AS, Gabel JC, Arens JF. Therapy of unilateral pulmonary insufficiency with a double lumen endotracheal tube. Crit Care Med. 1976;4:323–6.

    Article  CAS  Google Scholar 

  20. Powner D, Eross B, Grenvik A. Differential lung ventilation with PEEP in treatment of unilateral pneumonia. Crit Care Med. 1977;5:170–2.

    Article  CAS  Google Scholar 

  21. Anatham D, Jagadesan R, Tiew PEC. Clinical review: independent lung ventilation in critical care. Crit Care. 2005;9:594–600.

    Article  Google Scholar 

  22. Thomas A, Bryce T. Ventilation in the patient with unilateral lung disease. Crit Care Clin. 1998;14(4):743–73.

    Article  CAS  Google Scholar 

  23. Siegel JH, Stoklosa JC, Borg U, Wiles CE, Sganga G, Geisler FH, Belzberg H, Wedel S, Blevins S, Goh KC. Quantification of asymmetric lung pathophysiology as a guide to the use of simultaneous independent lung ventilation in posttraumatic and septic adult respiratory distress syndrome. Ann Surg. 1985;202:425–39.

    Article  CAS  Google Scholar 

  24. Carlon GC, Kahn R, Howland WS, et al. A case of life-threatening ventilation-perfusion inequality: an indication for independent lung ventilation. Crit Care Med. 1978a;6:380–3.

    Article  CAS  Google Scholar 

  25. Carlon GC, Ray C, Klein R, et al. Criteria for selective positive end-expiratory pressure and independent lung ventilation of each lung. Chest. 1978b;74:501–7.

    Article  CAS  Google Scholar 

  26. Hurst JM, DeHaven CB Jr, Branson RD. Comparison of conventional mechanical ventilation and synchronous independent lung ventilation (SILV) in the treatment of unilateral lung injury. J Trauma. 1985;25:766–70.

    Article  CAS  Google Scholar 

  27. Parish JM, Gracey DR, Southorn PA, Pairolero PA, Wheeler JT. Differential mechanical ventilation in respiratory failure due to severe unilateral lung disease. Mayo Clin Proc. 1984;59:888–90.

    Article  Google Scholar 

  28. Venus B, Pratap KS, Op’Tholt T. Treatment of unilateral pulmonary insufficiency by selective administration of continuous positive airway pressure through a double-lumen tube. Anesthesiology. 1980;53:74–7.

    Article  CAS  Google Scholar 

  29. Zandstra DF, Stoutenbeek CP, Bams JL. Monitoring lung mechanics and airway pressures during differential lung ventilation (DLV) with emphasis on weaning from DLV. Intensive Care Med. 1989;15:458–63.

    Article  CAS  Google Scholar 

  30. Baumann MH, Sahn SA. Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient. Chest. 1990;97:721–8.

    Article  CAS  Google Scholar 

  31. Pierson D. Management of bronchopleural fistula in the adult respiratory distress syndrome. New Horiz. 1993;1:512–21.

    CAS  Google Scholar 

  32. Kaiser L, Cooper JD, Trulock E, et al. The evolution of single lung transplant for emphysema. J Thorac Cardiovasc Surg. 1991;102:333–41.

    Article  CAS  Google Scholar 

  33. Adoumie R, et al. Differential lung ventilation: applications beyond the operating room. J Thorac Cardiovasc Surg. 1993;105:229–33.

    Article  CAS  Google Scholar 

  34. Kollef MH. Recurrent unilateral lung hyperinflation as a manifestation of “auto-PEEP”. Heart Lung. 1993;22:84–8.

    CAS  Google Scholar 

  35. Kollef MH, Turner JF. Intrinsic PEEP and unilateral lung hyperinflation. Pathophysiology and clinical significance. Chest. 1992;102:1220–4.

    Article  CAS  Google Scholar 

  36. Everloff SE, Rounds S, Braman SS. Unilateral lung hyperinflation and herniation as a manifestation of intrinsic PEEP. Chest. 1990;98:228–9.

    Article  Google Scholar 

  37. Hillman KM, Barber JD. Asynchronous independent lung ventilation (AILV). Crit Care Med. 1980;8:390–5.

    Article  CAS  Google Scholar 

  38. Marraro G, Marinari M, Rataggi M. The clinical application of synchronized independent lung ventilation (S.I.L.V.) in pulmonary disease with unilateral prevalence in pediatrics. Int J Clin Monit Comput. 1987;4:123–9.

    Article  CAS  Google Scholar 

  39. Charan NB, Cg C, Hawk P, Crowley JJ, Carvalho P. Independent lung ventilation with a single ventilator using a variable resistance valve. Chest. 1995;107:256–60.

    Article  CAS  Google Scholar 

  40. Roupie E, Dambrosio M, Servillo G, et al. Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995;152(1):121–8.

    Article  CAS  Google Scholar 

  41. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, Stewart TE, Briel M, Talmor D, Mercat A, Richard JC, Carvalho CR, Brower RG. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747–55.

    Article  CAS  Google Scholar 

  42. Katsaragakis S, Stamou K, Androulakis A. Independent lung ventilation for asymmetrical chest trauma: effect on ventilatory and haemodynamic parameters. Int J Care Injured. 2005;36:501–4.

    Article  Google Scholar 

  43. Di Nardo M, Perrotta D, Stoppa F, Cecchetti C, et al. Independent lung ventilation in a newborn with asymmetric acute lung injury due to respiratory syncytial virus: a case report. J Med Case Rep. 2008;2:212.

    Article  Google Scholar 

  44. Konstantinov I, Saxena P. Independent lung ventilation in the postoperative management of large bronchopleural fistula. J Thorac Cardiovasc Surg. 2010;139:e21–2.

    Article  Google Scholar 

  45. Papadakos P, Karcz M, Lachmann B. Mechanical ventilation in trauma. Curr Opin Anaesthesiol. 2010;23:228–32.

    Article  Google Scholar 

  46. Campos JH. An update on bronchial blockers during lung separation techniques in adults. Anesth Analg. 2003;97:1266–74.

    Article  Google Scholar 

  47. Cohen E. Methods of lung separation. Minerva Anestesiol. 2004;70:313–8.

    CAS  Google Scholar 

  48. Chen KP, Chan HC, Huang SJ. Foley catheter used as bronchial blocker for one lung ventilation in a patient with tracheostomy: a case report. Acta Anaesthesiol Sin. 1995;33:41–4.

    CAS  Google Scholar 

  49. Park HP, Bahk JH, Park JH, Oh YS. Use of a Fogarty catheter as a bronchial blocker through a single-lumen endotracheal tube in patients with subglottic stenosis. Anaesth Intensive Care. 2003;31:214–6.

    Article  CAS  Google Scholar 

  50. Campos JH, Kernstine KH. A comparison of a left-sided Broncho-Cath with the torque control blocker Univent and the wire-guided blocker. Anesth Analg. 2003;96:283–9.

    Google Scholar 

  51. Bauer C, Winter C, Hentz JG, Duerocq X, Steib A, Dupeyron JP. Bronchial blocker compared to double-lumen tube for one-lung ventilation during thoracoscopy. Acta Anaesthesiol Scand. 2001;45:250–4.

    CAS  Google Scholar 

  52. Tsai KM. Lung isolation update. Sem anesthesia, perioperative. Med Pain. 2003;22:88–105.

    Google Scholar 

  53. Inoue H, Shotsu A, Ogawa J, et al. New device for one-lung anesthesia: endotracheal tube with moveable blocker. Thorac Cardiovasc Surg. 1982;83:940–1.

    Article  CAS  Google Scholar 

  54. Gayes JM. Pro: one-lung ventilation is best accomplished with the Univent endotracheal tube. J Cardiothor Vasc Anesth. 1993;7:103–7.

    Article  CAS  Google Scholar 

  55. Kelley JG, Gaba DM, Brodsky JB. Bronchial cuff pressures of two tubes used in thoracic surgery. J Cardiothor Vasc Anesth. 1992;6:190–2.

    Article  CAS  Google Scholar 

  56. Campos JH. Lung isolation. In: Slinger P, editor. Principles and practice of anesthesia for thoracic surgery. New York: Springer; 2011. p. 227–46.

    Chapter  Google Scholar 

  57. Burton NA, Watson DC, Brodsky JB, et al. Advantages of a new polyvinyl chloride double lumen tube in thoracic surgery. Ann Thorac Surg. 1983;36:78–84.

    Article  CAS  Google Scholar 

  58. Brodsky JB, Mihm FG. Spit-lung ventilation. In: Hall JB, Schmidt GA, Wood LDH, editors. Principles of Critical Care. New York: McGraw-Hill; 1992. p. 160–4.

    Google Scholar 

  59. Benumof JL, Patridge BL, Salvatierra C, et al. Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology. 1987;67:729.

    Article  CAS  Google Scholar 

  60. Strange C. Double-lumen endotracheal tubes. Clin Chest Med. 1991;12:12497–506.

    Article  Google Scholar 

  61. Alfrey DD. Double-lumen endobronchial tube intubation using a retrograde wire technique. Anesth Analg. 1993;76:1374–5.

    Article  Google Scholar 

  62. Benumof JL. Separation of the two lungs (double-lumen tube intubation). In: Anesthesia for thoracic surgery. 2nd ed. Philadelphia, PA: WB Saunders; 1995. p. 223–58.

    Google Scholar 

  63. Coe VL, Brodsky JB, Mark JBD. Double-lumen endobronchial tubes in patients with tracheostomies. Anesth Analg. 1984;63:882.

    Article  CAS  Google Scholar 

  64. Taylor S, Walford A, McLellan I. A disposable double-lumen tracheostomy tube: a prototype. Anaesth Intensive Care. 1984;12:57.

    Article  CAS  Google Scholar 

  65. Lieberman D, Littleford J, Horan T, Unruth H. Placement of left double-lumen endobronchial tubes with or without stylet. Can J Anaesth. 1996;43:238–42.

    Article  CAS  Google Scholar 

  66. Smith GB, Hirsch NP, Ehrenwerth J. Placement of double-lumen endobronchial tubes. Br J Anaesth. 1986;58:1317–20.

    Article  CAS  Google Scholar 

  67. McKenna MJ, Wilson RS, Botelho RJ. Right upper lobe obstruction with right-sided double-lumen endobronchial tubes: a comparison of two types. Cardiothorac Vasc Anesth. 1988;2:734–40.

    Article  CAS  Google Scholar 

  68. Alliaume B, Coddens J, Deloof T. Reliability of auscultation in positioning double-lumen endotracheal tubes. Can J Anaesth. 1992;39:687–90.

    Article  CAS  Google Scholar 

  69. Campos JH. Update on tracheobronchial anatomy and flexible fiberoptic bronchoscopy in thoracic anesthesia. Curr Opin Anaesthesiol. 2009;22:4–10.

    Article  Google Scholar 

  70. Brodsky JB, Mark JB. Balloon method for detecting inadequate double-lumen tube cuff seal. Ann Thorac Surg. 1993;55:1584.

    Article  CAS  Google Scholar 

  71. Spragg RG, Benumof JL, Alfery DD. New methods in the performance of unilateral lung lavage. Anesthesiology. 1982;57:535.

    Article  CAS  Google Scholar 

  72. Inoue S, Nishimine N, Kitaguchi K, Furuya H, Taniguchi S. Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation. Br J Anaesth. 2004;92:195–201.

    Article  CAS  Google Scholar 

  73. Shankar KB, Moseley HSL, Kumar AY. Dual end-tidal CO, monitoring and double-lumen tubes. Can J Anaesth. 1991;39:100–1.

    Article  Google Scholar 

  74. Bardoczky GI, Levarlet M, Engelman E, et al. Continuous spirometry for detection of double lumen endobronchial tube displacement. Br J Anaesth. 1993;70:499–502.

    Article  CAS  Google Scholar 

  75. Iwasaka H, Itoh K, Miyakawa H, Taniguchi K, Honda N. Continuous monitoring of ventilatory mechanics during one-lung ventilation. J Clin Monit. 1996;12(161):164.

    Google Scholar 

  76. Szegedi LL, Bardoczky GI, Engelman EE, d’Hollander AA. Airway pressure changes during one-lung ventilation. Anesth Analg. 1997;84:1034–7.

    Article  CAS  Google Scholar 

  77. Sivalingam P, Tio R. Tension pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema in a 15-year-old Chinese girl after a double-lumen tube intubation and one-lung ventilation. J Cardiothor Vasc Anesth. 1999;13:312–5.

    Article  CAS  Google Scholar 

  78. Clapham MC, Vaughan RS. Bronchial intubation: a comparison between polyvinyl chloride and red rubber double-lumen tubes. Anaesthesia. 1985;40:1111.

    Article  CAS  Google Scholar 

  79. Brodsky JB. Complications of double-lumen tracheal tubes. Probl Anesth. 1988;2:292.

    Google Scholar 

  80. Brodsky JB, Adkins MO, Gaba DM. Bronchial cuff pressures of double-lumen tubes. Anesth Analg. 1989;69:608–10.

    Article  CAS  Google Scholar 

  81. Claypool WD, Rogers RM, Matuschak GM. Update on the clinical diagnosis, management, and pathogenesis of pulmonary alveolar proteinosis (phospholipidosis). Chest. 1984;85:550–8.

    Article  CAS  Google Scholar 

  82. Rocke DA. Percutaneous lung biopsy. Anaesthesia. 1984;39:888–90.

    Article  CAS  Google Scholar 

  83. Wendt M, et al. Differential ventilation with low-flow CPAP and CPPV in the treatment of unilateral chest trauma. Intensive Care Med. 1989;15:209–11.

    Article  CAS  Google Scholar 

  84. Inoue H, et al. Selective exclusion of the injured lung. J Trauma. 1993;34:496–8.

    Article  CAS  Google Scholar 

  85. Hedenstiema G, Baehrendtz S, Klingstedt C, et al. Ventilation and perfusion of each lung during differential ventilation with selective PEEP. Anesthesiology. 1984;61:369.

    Article  Google Scholar 

  86. Gavazzeni V, Iapichino G, Mascheroni D, Langer M, Bordone G, Zannini P, Radrizzani D, Damia G. Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema. Chest. 1993;103:96–100.

    Article  CAS  Google Scholar 

  87. Narr BJ, Fromme GA, Peters SG. Unilateral bronchospasm during pleurodesis in an asthmatic patient. Chest. 1990;98:767–8.

    Article  CAS  Google Scholar 

  88. Berg S, Bittner EA, Berra L, Kacmarek RM, Sonny A. Independent lung ventilation: implementation strategies and review of literature. World J Crit Care Med. 2019;8(4):49–58.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Critical Medicine, UCI Hospital Pacifica Salud/Johns Hopkins Medicine, Panama City, Panama

    Jorge E. Sinclair Ávila

  2. Faculty of Medicine, University of Panama, Panama City, Panama

    Jorge E. Sinclair De Frías

  3. Biochemistry, Arizona State University, Phoenix, AZ, USA

    Allyson Hidalgo

Authors
  1. Jorge E. Sinclair Ávila
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jorge E. Sinclair De Frías
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allyson Hidalgo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Critical Care Division Belize Healthcare Partners, Belize, Belize

    Jorge Hidalgo

  2. Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C Hyzy

  3. Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates

    Ahmed Mohamed Reda Taha

  4. Critical Care, King Faisal Specialist Hospital & Research, Riyadh, Saudi Arabia

    Yasser Younis A. Tolba

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sinclair Ávila, J.E., Sinclair De Frías, J.E., Hidalgo, A. (2022). Unilateral Lung Diseases and Differential Lung Ventilation. In: Hidalgo, J., Hyzy, R.C., Mohamed Reda Taha, A., Tolba, Y.Y.A. (eds) Personalized Mechanical Ventilation . Springer, Cham. https://doi.org/10.1007/978-3-031-14138-6_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-14138-6_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-14137-9

  • Online ISBN: 978-3-031-14138-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation