Independent lung ventilation: Implementation strategies and review of literature

Berg, Sheri; Bittner, Edward A.; Kacmarek, Robert M.; Sonny, Abraham

doi:10.5492/wjccm.v8.i4.49

Cited by 14 publications

(18 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These limitations combined with the absence of robust data about mortality and complications, render ILV used only as a rescue therapy. 24 25 Experimentally, tracheal gas insufflation (TGI) has been proposed to manage patients with unilateral lung injury. 26 TGI in combination with partial liquid ventilation has also been successfully tested on unilateral lung injury model 27 with better results than TGI alone.…”

Section: History Of General Approaches For Ventilation Of Asymmetrica...mentioning

confidence: 99%

Asymmetrical Lung Injury: Management and Outcome

Bastia

Rozé

Brochard

2022

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Among mechanically ventilated patients, asymmetrical lung injury is probably extremely frequent in the intensive care unit but the lack of standardized measurements does not allow to describe any prevalence among mechanically ventilated patients. Many past studies have focused only on unilateral injury and have mostly described the effect of lateral positioning. The good lung put downward might receive more perfusion while the sick lung placed upward receive more ventilation than supine. This usually results in better oxygenation but can also promote atelectasis in the healthy lung and no consensus has emerged on the clinical indication of this posture. Recently, electrical impedance tomography (EIT) has allowed for the first time to precisely describe the distribution of ventilation in each lung and to better study asymmetrical lung injury. At low positive-end-expiratory pressure (PEEP), a very heterogeneous ventilation exists between the two lungs and the initial increase in PEEP first helps to recruit the sick lung and protect the healthier lung. However, further increasing PEEP distends the less injured lung and must be avoided. The right level can be found using EIT and transpulmonary pressure. In addition, EIT can show that in the two lungs, airway closure is present but with very different airway opening pressures (AOPs) which cannot be identified on a global assessment. This may suggest a very different PEEP level than on a global assessment. Lastly, epidemiological studies suggest that in hypoxemic patients, the number of quadrants involved has a strong prognostic value. The number of quadrants is more important than the location of the unilateral or bilateral nature of the involvement for the prognosis, and hypoxemic patients with unilateral lung injury should probably be considered as requiring lung protective ventilation as classical acute respiratory distress syndrome.

show abstract

Section: History Of General Approaches For Ventilation Of Asymmetrica...mentioning

confidence: 99%

Asymmetrical Lung Injury: Management and Outcome

Bastia

Rozé

Brochard

2022

Semin Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…However, SLT often causes native lung hyperinflation (NLH), which may be induced by asymmetrical distribution of gas flow with air-trapping in the native lung due to the marked difference in compliance between the highly compliant native lung and restrictive donor lung (2,7). NLH is particularly prone to occur under positive-pressure mechanical ventilation and may be worsened by donor lung edema due to ischemic reperfusion injury, ventilator-induced lung injury or primary allograft dysfunction (8,9). NLH may cause mediastinum shift and extrinsic allograft compression, resulting in atelectasis, impaired gas exchange and hemodynamic instability, which may require specific ventilator strategies or lung volume reduction surgery (2,8,9).…”

Section: Introductionmentioning

confidence: 99%

“…NLH is particularly prone to occur under positive-pressure mechanical ventilation and may be worsened by donor lung edema due to ischemic reperfusion injury, ventilator-induced lung injury or primary allograft dysfunction (8,9). NLH may cause mediastinum shift and extrinsic allograft compression, resulting in atelectasis, impaired gas exchange and hemodynamic instability, which may require specific ventilator strategies or lung volume reduction surgery (2,8,9).…”

Section: Introductionmentioning

confidence: 99%

Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema

et al. 2022

View full text Add to dashboard Cite

Background : We herein report the use of independent lung ventilation (ILV) for managing acute allograft rejection after single-lung transplantation (SLT) for end-stage emphysema. Case presentation : A 54-year-old woman was transferred to our hospital with severe hypoxemia and respiratory distress due to unilateral lung disease with diffuse alveolar damage in the right donor lung associated with acute allograft rejection and with hyperinflation of the left native lung due to emphysema. She was unresponsive to immunosuppressive medications and conventional ventilation strategies, so different ventilator settings for each lung were required. A double-lumen endotracheal tube (DLT) was inserted, and ILV was initiated. The right lung was ventilated with high positive end-expiratory pressure (PEEP), intended for lung recruitment, and the left lung was ventilated with lung protective strategies using a low tidal volume and low levels of PEEP to avoid hyperinflation. Two days later, her lung function was dramatically improved, and the DLT was replaced with a single-lumen endotracheal tube. Gas exchange was maintained, and she was successfully weaned from mechanical ventilation on intensive-care unit day 15. Conclusions : ILV appears to be effective and safe for managing acute allograft rejection after SLT for emphysema.

show abstract

“…In such cases, each lung needs to be ventilated independently in order to avoid damage to the more affected lung and to speed up its recovery, while allowing the other lung to ventilate properly. ILV requires the use of a left or right sided double-lumen endotracheal tube (ETT) and in most cases, it is carried out using two ventilators not always synchronized [ 2 ]. Our current project (LIDER/19/0107/L-8/16/NCBR/2017) is focused on the development of a device for synchronous ILV, design for work with only one ventilator.…”

Section: Introductionmentioning

confidence: 99%

Independent Lung Ventilation-Experimental Studies on a 3D Printed Respiratory Tract Model

et al. 2021

View full text Add to dashboard Cite

Independent lung ventilation (ILV) is a life-saving procedure in unilateral pulmonary pathologies. ILV is underused in clinical practice, mostly due to the technically demanding placement of a double lumen endotracheal tube (ETT). Moreover, the determination of ventilation parameters for each lung in vivo is limited. In recent years, the development of 3D printing techniques enabled the production of highly accurate physical models of anatomical structures used for in vitro research, considering the high risk of in vivo studies. The purpose of this study was to assess the influence of double-lumen ETT on the gas transport and mixing in the anatomically accurate 3D-printed model of the bronchial tree, with lung lobes of different compliances, using various ventilation modes. The bronchial tree was obtained from Respiratory Drug Delivery (RDD Online, Richmond, VA, USA), processed and printed by a dual extruder FFF 3D printer. The test system was also composed of left side double-lumen endotracheal tube, Siemens Test Lung 190 and anesthetic breathing bag (as lobes). Pressure and flow measurements were taken at the outlets of the secondary bronchus. The measured resistance increased six times in the presence of double-lumen ETT. Differences between the flow distribution to the less and more compliant lobe were more significant for the airways with double-lumen ETT. The ability to predict the actual flow distribution in model airways is necessary to conduct effective ILV in clinical conditions.

show abstract

Independent lung ventilation: Implementation strategies and review of literature

Cited by 14 publications

References 33 publications

Asymmetrical Lung Injury: Management and Outcome

Asymmetrical Lung Injury: Management and Outcome

Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema

Independent Lung Ventilation-Experimental Studies on a 3D Printed Respiratory Tract Model

Contact Info

Product

Resources

About