Criteria for Selective Positive End-Expiratory Pressure and Independent Synchronized Ventilation of Each Lung

Carlon, Graziano C.; Ray, Cole; Klein, Roy; Goldiner, Paul L.; Miodownik, Saul

doi:10.1378/chest.74.5.501

Cited by 87 publications

(17 citation statements)

References 9 publications

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“…The use of positioning and differential lung ventilation has been described in this situation. [30][31][32] Placing the "good lung down" may increase PaO 2 by 1.5-2.0 kPa as blood flow increases to the well ventilated lung. Differential lung ventilation requires the placement of a double lumen tube.…”

Section: Respiratory Managementmentioning

confidence: 99%

The pulmonary physician in critical care 3: Critical care management of community acquired pneumonia

Baudouin

2002

Thorax

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Section: Respiratory Managementmentioning

confidence: 99%

The pulmonary physician in critical care 3: Critical care management of community acquired pneumonia

Baudouin

2002

Thorax

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“…This may result in redistribution of blood flow from the overdistended normal lung to the injured lung, thereby increasing the degree of intrapulmonary shunt. Currently, differential ventilation with selective PEEP (1,23) and positioning the patient with the "good lung down" (6,24) are the two accepted treatments to improve oxygenation in severe unilateral lung injury. However, both techniques have serious limitations in clinical practice.…”

Section: Selecting Peep In Patients With Unilateral Lung Injurymentioning

confidence: 99%

“…In the setting of unilateral lung injury, measurement of global respiratory system mechanics does not provide clinically useful information to set ventilator parameters (PEEP or tidal volume) because the mechanical impairment of the injured parts of the lung cannot be specifically assessed (1,2). In fact, some patients with acute respiratory distress syndrome (ARDS) presenting with consolidated lower lung lobes that cannot be recruited present a gas exchange response to increasing levels of positive end-expiratory pressure (PEEP) similar to that described in patients with unilateral lung injury (3).…”

mentioning

confidence: 99%

Application of Tracheal Gas Insufflation to Acute Unilateral Lung Injury in an Experimental Model

Blanch

Kloot²,

Youngblood³

et al. 2001

Am J Respir Crit Care Med

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In unilateral lung injury, application of global positive end-expiratory pressure (PEEP) may cause overdistension of normal alveoli and redistribution of blood flow to diseased lung areas, thereby worsening oxygenation. We hypothesized that selective application of tracheal gas insufflation (TGI) will recruit the injured lung without causing overdistension of the normal lung. In eight anesthetized dogs, left lung saline lavage was performed until Pa(O(2))/FI(O(2)) fell below 100 mm Hg. Then, the dogs were reintubated with a Univent single lumen endotracheal tube that incorporates an internal catheter to provide TGI. After injury, increasing PEEP from 3 to 10 cm H(2)O did not change gas exchange, hemodynamics, or lung compliance. Selective TGI, while keeping end-expiratory lung volume (EELV) constant, improved Pa(O(2))/FI(O(2)) from 212 +/- 43 to 301 +/- 38 mm Hg (p < 0.01) while Pa(CO(2)) and airway pressures decreased (p < 0.01). During selective TGI, reducing tidal volume to 5.2 ml/kg while keeping EELV constant, normalized Pa(CO(2)), did not affect Pa(O(2))/FI(O(2)), and decreased end-inspiratory plateau pressure from 16.6 +/- 1.0 to 11.9 +/- 0.5 cm H(2)O (p < 0.01). In unilateral lung injury, we conclude that selective TGI (1) improves oxygenation at a lower pressure cost as compared with conventional mechanical ventilation, (2) allows reduction in tidal volume without a change in alveolar ventilation, and (3) may be a useful adjunct to limit ventilator-associated lung injury.

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“…Ensuring an appropriate level of ventilation is particularly difficult during decortication of the visceral pleura due to gas leakage from the affected lung. Differential lung ventilation (DLV), which involves separate ventilation of the left and right lungs using two ventilators, has been employed in some cases where a single lung was predominantly affected by lesions [1]. However, there have not been any reports about the utility of combining DLV with visceral pleurectomy/decortication to treat malignant pleural mesothelioma.…”

Section: Introductionmentioning

confidence: 99%

Anesthetic Management of Pleurectomy/Decortication Under Differential Lung Ventilation

et al. 2018

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A 64-year-old male (a building demolition worker) was diagnosed with malignant left-sided pleural mesothelioma, and left-sided pleurectomy/decortication was scheduled. Differential lung ventilation (DLV) was performed during the removal of the visceral pleura by connecting the affected lung to a ventilator and the healthy lung to an anesthesia machine, and then separately ventilating the left and right lungs. Anesthetic management using DLV was successfully established without causing significant changes in oxygenation or circulatory dynamics.

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Criteria for Selective Positive End-Expiratory Pressure and Independent Synchronized Ventilation of Each Lung

Cited by 87 publications

References 9 publications

The pulmonary physician in critical care 3: Critical care management of community acquired pneumonia

The pulmonary physician in critical care 3: Critical care management of community acquired pneumonia

Application of Tracheal Gas Insufflation to Acute Unilateral Lung Injury in an Experimental Model

Anesthetic Management of Pleurectomy/Decortication Under Differential Lung Ventilation

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