title: Clinical use of differential lung ventilation in the treatment of asymmetric lung injury: report of a case.
abstract: Successful treatment of a 26-year-old male with asymmetric lung injury following a traffic accident is described. The patient was admitted with head injuries, right lung contusion, right pneumothorax, and multiple rib fractures (right 1-9). He developed a left pneumohemothorax and complete atelectasis of the lower lobe of the left lung two days later. Conventional mechanical ventilation with and without positive end-expiratory pressure (PEEP), supplemented by repeated therapeutic bronchoscopy, failed to reexpand the left lung. After 16 days of atelectasis, synchronized differential lung ventilation using a double lumen endobronchial tube connected to two ventilators (Siemens 900C) was instituted. Measurement of the tidal volume and static compliance of each lung showed marked inequality and 9 cm H2O of PEEP was applied selectively to the left lung (zero PEEP to the right) in an attempt to equalize tidal volumes. Evident improvement in blood gases and chest radiograph was obtained within 30 min but weaning back to a single lumen tube required 6 days, and was complicated by further episodes of atelectasis. Complete pulmonary and neurological recovery was obtained, and a normal chest radiograph was documented 3 months later. Differential ventilation proved simple to use, and highly effective in the management of this combination of lung problems.
authors.forename: A R
authors.initials: AR
authors.lastname: Talbot
authors.forename: C C
authors.initials: CC
authors.lastname: Fu
mesh_terms: D000328:Adult; D006801:Humans; D055370:Lung Injury; D008297:Male; D009104:Multiple Trauma / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*