Acute life-threatening ventilation-perfusion inequality: an indication for independent lung ventilation

Carlon, Graziano C.; Kahn, Robert J.; Howland, William S.; Baron, R.M.; Ramaker, Judson

doi:10.1097/00003246-197811000-00009

Cited by 58 publications

(17 citation statements)

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“…Moreover, this imbalance may be worsened by the application of general PEEP which may increase the compliance and thus the ventilaton of the less affected or unaffected lung. Adverse effects of general PEEP in unilateral lung disease have also been reported in the literature (8,1). Under such circumstances it would seem rational to direct ventilation to the lung separately, in order to improve the matching between ventilation and perfusion.…”

Section: Ventilation and Perfusion In Unilateral Lung Diseasementioning

confidence: 88%

“…The method of ventilating each lung separately (independent or differential ventilation), with or without application of positive end expiratory pressure (PEEP) to one or both lungs has been used in selected cases of severe unilateral or non-homogeneous lung disease in order to improve the matching of ventilation and perfusion and thereby to enhance gas exchange (1,2). It has also become a valuable tool during thoracic surgery, in the form of one-lung ventilation, facilitating intervention in the non-ventilated lung (3,4).…”

Section: Introductionmentioning

confidence: 99%

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Practical aspects of differential ventilation with selective peep in acute respiratory failure

Hedenstierna

Baehrendtz

Darowski

et al. 1984

J Clin Monit Comput

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Hypoxaemia in association with acute respiratory failure continues to be a severe problem in some intensive care patients. Among strategies proposed, we want to focus attention on differential ventilation with selective PEEP, administered in the lateral position. This ventilation technique has proved successful in the treatment of refractory hypoxaemia due to severe bilateral lung disease. The rationale of this concept is briefly presented in this paper, where the main emphasis is laid on the practical aspects of its clinical application. Two case reports are included as examples of our experiences.

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Section: Ventilation and Perfusion In Unilateral Lung Diseasementioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Practical aspects of differential ventilation with selective peep in acute respiratory failure

Hedenstierna

Baehrendtz

Darowski

et al. 1984

J Clin Monit Comput

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“…We should mention that general PEEP application can improve gas exchange, but it decreases cardiac output [ 24 ] and diverts flow into the less compliant lung [ 25 ]. Only selective PEEP into the dependent lung can improve ventilation/perfusion matching [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

et al. 2017

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IntroductionAdequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device’s utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position.Materials and methods69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance.ResultsOur results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position.ConclusionsWe report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.

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“…This may be caused by an increase in the proportion of blood passing through intrapulmonary shunt pathways, but may also result from a reduction in mixed venous Po 2 secondary to a reduction in cardiac output in the presence of an unchanged Qs/Qt [29,30]. However, a number of authors have recorded increases in Qs/Qt in response to PEEP in patients with predominantly unilateral disease [4][5][6], and Kanarek and Shannon [7] obtained measurements which confirmed the redistribution of flow to the damaged lung in response to 5 and 15 cm H 2 O PEEP in one patient who had been subjected to trauma and who had developed unilateral pneumonia. It is known that trauma to the lung can release prostacyclin which inhibits HPV [31].…”

Section: Discussionmentioning

confidence: 99%

Effects of Altered Patterns of Ventilation and of Increased Cardiac Output on Blood Flow to a Collapsed Lung in Anaesthetized, Closed-Chest Dogs

Niblett

Cannon

Sykes

1988

British Journal of Anaesthesia

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Right-to-left shunt (Qs/Qt) was measured by the SF6 and oxygen methods in 13 anaesthetized closed-chest dogs intubated with a double-lumen endobronchial tube. Collapse of the left lung increased Qs/Qt from 10% to 23%, suggesting that blood flow to the left lung had been reduced by about 60%. Increasing right lung mean airway pressure by the alteration of the inspiratory:expiratory time ratio or the application of PEEP produced a small but non-significant increase in Qs/Qt with significant increases in arterial and mixed venous carbon dioxide tensions, and arterial to right lung end-tidal carbon dioxide tension difference. Fluid loading during collapse increased cardiac output and pulmonary vascular pressures, but Qs/Qt did not differ significantly from the normovolaemic collapsed state. Increasing the right mean airway pressure in this condition had no effect on Qs/Qt or carbon dioxide tensions.

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Acute life-threatening ventilation-perfusion inequality: an indication for independent lung ventilation

Cited by 58 publications

References 0 publications

Practical aspects of differential ventilation with selective peep in acute respiratory failure

Practical aspects of differential ventilation with selective peep in acute respiratory failure

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

Effects of Altered Patterns of Ventilation and of Increased Cardiac Output on Blood Flow to a Collapsed Lung in Anaesthetized, Closed-Chest Dogs

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