Background
There has been loss of interested in Independent Lung Ventilation (ILV) over the recent years. Reasons could be unfamiliarity with the technique, lack of guidelines or even publications. On the other side, we are faced with better accessibility of extra corporeal oxygenation modalities such as veno-venous extracorporeal membrane oxygenation (V-V ECMO) and extra corporeal CO2 removal (ECO2R).
With ILV specially designed double lumen endotracheal tubes (DLET) are used that enable separate lung ventilation using 2 ventilators. While single lumen ventilation is well known to anesthesiologist, its use together the use of ILV is seldom used in ICU. ILV can offer valuable rescue therapy for refractory hypoxemia in patients with predominantly unilateral lung injury especially in non ECMO centres or as a bridge to definite therapy (ECMO, surgery, bronchial artery embolisation etc).
It is shown that ILV improves aeration, oxygenation and CO2 clearance in patients with predominant unilateral lung injury as well as reduces intrapulmonary shunt and eliminates inhomogeneity during mechanical ventilation (MV). Protective MV with 6 mL / kg Ideal Body Mass (IBM) will inevitably lead to over distention and hyperventilation ob uninjured lung leaving the injured lung under-distended or collapsed. Pendelluft phenomenon has been reported to be present in predominantly unilateral lung disease / injuries due to differences in time constants in lungs.
Unfortunately, there’s a lack of double blind multi central studies about the use of ILV. While using it, we rely on scarce body of evidence from the literature based ob observational data and case series, applying physiology principles and fallowing protective ventilation guidelines.
Key words: independent lung ventilation, ICU
