title: A novel technique of differential lung ventilation in the critical care setting.
abstract: BACKGROUND
  Differential lung ventilation (DLV) is used to salvage ventilatory support in severe unilateral lung disease in the critical care setting. However, DLV with a double-lumen tube is associated with serious complications such as tube displacement during ventilatory management. Thus, long-term ventilatory management with this method may be associated with high risk of respiratory incidents in the critical care setting.
  
  
  RESULTS
  We devised a novel DLV technique using two single-lumen tubes and applied it to five patients, two with severe unilateral pneumonia and three with thoracic trauma, in a critical care setting. In this novel technique, we perform the usual tracheotomy and insert two single-lumen tubes under bronchoscopic guidance into the main bronchus of each lung. We tie the two single-lumen tubes together and suture them directly to the skin. The described technique was successfully performed in all five patients. Pulmonary oxygenation improved rapidly after DLV induction in all cases, and the three patients with thoracic trauma were managed by DLV without undergoing surgery. Tube displacement was not observed during DLV management. No airway complications occured in either the acute or late phase regardless of the length of DLV management (range 2-23 days).
  
  
  CONCLUSIONS
  This novel DLV technique appears to be efficacious and safe in the critical care setting.
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka 565-0871, Japan. k.yamakawa0911@gmail.com.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Yamakawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakamori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujimi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kuwagata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu