Differential lung ventilation

  • Dwayne R. Westenskow
  • Nathan L. Pace
Part of the Developments in Critical Care Medicine and Anaesthesiology book series (DCCA, volume 1)


The isolation of gas flow to the right and left lung was introduced in 1932 by Jacobaeus et al. [22] to study unilateral lung function (bronchospirometry). The ease of performing bronchospirometry was enhanced by Carlens’ development of a practical, two- luman endotracheal tube [11]. The unpleasantness of awake endotracheal intubation has prompted newer noninvasive methods to assess unilateral lung function [2]; bronchospirometry has essentially been abandoned as a diagnostic tool. However, the Carlens-type tube was quickly introduced to thoracic surgery anesthesia [41]. The isolation of the two lungs during surgery allowed one-lung anesthesia, giving protection to the unoperated lung from blood, secretions and pus; a quiet operating field; and preservation of gas flow to the unoperated lung during tracheal and bronchial resections or with bronchopleural fistulae repair.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bachofen M, Weibel ER: Alterations of the gas exchange apparatus in adult respiratory insufficiency associated,with septicemia. Am Rev Respir Dis 116: 589–615, 1977.PubMedGoogle Scholar
  2. 2.
    Baier H: Assessment of unilateral lung function. Anesthesiology 52: 240–247, 1980.PubMedCrossRefGoogle Scholar
  3. 3.
    Bartlet RH: Respiratory care of the surgical or traumatized patient. In: Burton GG, Gee GN, Hodgkin JE (eds) Respiratory care: a guide to clinical practice. Philadelphia: JB Lippincott, 1977, pp 874–892.Google Scholar
  4. 4.
    Bendixen HH, Egbert LD, Hedley-Whyte J, et al: Respiratory care. St Louis: CV Mosby, 1965, pp 162 and 163.Google Scholar
  5. 5.
    Benumof JL, Rogers SN, Moyce PR, et al: Hypoxic pulmonary vasoconstriction and regional and whole-lung PEEP in the dog. Anesthesiology 51: 503–507, 1979.PubMedCrossRefGoogle Scholar
  6. 6.
    Brown CR: Postpneumonectomy empyema and bronchopleural fistula - use of prolonged endobronchial intubation: a case report. Anesth Analg (Cleve) 52: 439–441, 1973.Google Scholar
  7. 7.
    Carlon GC, Kahn R, Howlands WS, et al: Acute life-threatening ventilation-perfusion inequality: an indication for independant lung ventilation. Crit Care Med 6: 380–383, 1978.PubMedCrossRefGoogle Scholar
  8. 8.
    Carlon GC, Kahn RC, Howland WS, et al: Clinical experience with high frequency jet ventilation. Crit Care Med 9: 1–6, 1981.PubMedCrossRefGoogle Scholar
  9. 9.
    Carlon GC, Ray C Jr, Klein R, et al: Criteria for selective positive end-expiratory pressure and independent synchronized ventilation of each lung. Chest 74: 501–507, 1978.PubMedCrossRefGoogle Scholar
  10. 10.
    Carlon GC, Ray C Jr, Klain M, et al: High-frequency positive-pressure ventilation in management of a patient with bronchopleural fistula. Anesthesiology 52: 160–162, 1980.PubMedGoogle Scholar
  11. 11.
    Carlens E: A new flexible double-lumen catheter for bronchospirometry. J Thorac Surg 18: 742–746, 1949.PubMedGoogle Scholar
  12. 12.
    Cavanilles JM, Garrigosa F, Prieto C, et al: A selective ventilation distribution circuit (S.V. D.C.). Intensive Care Med 5: 95–98, 1979.PubMedCrossRefGoogle Scholar
  13. 13.
    Downs JB, Chapman RL Jr: Treatment of bronchopleural fistula during continuous positive pressure ventilation. Chest 69: 363–366, 1976.PubMedCrossRefGoogle Scholar
  14. 14.
    Falke KJ, Pontoppidan H, Kumar A, et al: Ventilation with end-expiratory pressure in acute lung disease. J Clin Invest 51: 2315–2323, 1972.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Fowler AA III, Scoggins WG, O’Donohue WJ Jr: Positive end-expiratory pressure in the management of lobar atelectasis. Chest 74: 497–500, 1978.PubMedCrossRefGoogle Scholar
  16. 16.
    Gallagher TJ, Banner MJ, Smith RA: A simplified method of independent lung ventilation. Crit Care Med 8: 396–399, 1980.PubMedCrossRefGoogle Scholar
  17. 17.
    Gallagher TJ, Smith RA, Kirby RR, et al: Intermittent inspiratory chest tube occlusion to limit bronchopleural cutaneous airleaks. Crit Care Med 4: 328–332, 1976.PubMedCrossRefGoogle Scholar
  18. 18.
    Gilston A: The effects of PEEP on arterial oxygenation. Intensive Care Med 3: 267–271, 1977.PubMedCrossRefGoogle Scholar
  19. 19.
    Glass DD, Tonnesen AS, Gabel JC, et al: Therapy of unilateral pulmonary insufficiency with a double-lumen endobronchial tube. Crit Care Med 4: 323–326, 1976.PubMedCrossRefGoogle Scholar
  20. 20.
    Hilberman M: The evolution of the intensive care unit. Crit Care Med 3: 159–165, 1975.PubMedCrossRefGoogle Scholar
  21. 21.
    Hillman KM, Barber JD: Asynchronous independent lung ventilation (AILV). Crit Care Med 8: 390–395, 1980.PubMedCrossRefGoogle Scholar
  22. 22.
    Jacobaeus JC, Frenckner P, Bjorkman S: Some attempts at determining the volume and function of each lung separately. Acta Med Scand 79: 174–507, 1932.CrossRefGoogle Scholar
  23. 23.
    Jardin F, Desfond P, Bazin M, et al: Controlled ventilation with best positive end-expiratory pressure (PEEP) and high level PEEP in acute respiratory failure (ARF). Intensive Care Med 7: 171–176, 1981.PubMedCrossRefGoogle Scholar
  24. 24.
    Kanarek DJ, Shannon DC: Adverse effect of positive end-expiratory pressure on pulmonary perfusion and oxygenation. Am Rev Respir Dis 112: 457–459, 1975.PubMedGoogle Scholar
  25. 25.
    Lamy M, Fallat RJ, Koeniger E, et al: Pathologic features and mechanisms of hypoxemia in adult respiratory distress syndrome. Am Rev Respir Dis 114: 267–284, 1976.PubMedGoogle Scholar
  26. 26.
    Light RB, Mink SN, Wood LDH: The effect of unilateral PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia. Anesthesiology 55: 251–255, 1981.PubMedCrossRefGoogle Scholar
  27. 27.
    Maewall HK, Kirk BW: Balloon catheter reexpansion of atelectatic lung. Crit Care Med 4: 301–303, 1976.CrossRefGoogle Scholar
  28. 28.
    Millen JE, Vandree J,Glauser FL: Fiberopticbronchoscopicballoon occlusion and re-expansion of refractory atelectasis. Crit Care Med 6: 50–55, 1978.PubMedCrossRefGoogle Scholar
  29. 29.
    Mink S, Light RB, Colligan T, et al: The effect of PEEP on pulmonary gas exchange and pulmonary perfusion in canine lobar pneumonia. J Appl Physiol 50: 517–523, 1981.PubMedGoogle Scholar
  30. 30.
    Miranda DR, Stoutenbeck C, Kingma L: Differential lung ventilation with HFPPV. intensive Care Med 7: 139–141, 1981.CrossRefGoogle Scholar
  31. 31.
    Peterson BM: Balloon directed pulmonary blood flow. Crit Care Med 9: 540–543, 1981.PubMedCrossRefGoogle Scholar
  32. 32.
    Phillips YY, Lonigan RM, Joyner LR: A simple technique for managing a bronchopleural fistula while maintaining positive pressure ventilation. Crit Care Med 7: 351–353, 1979.PubMedCrossRefGoogle Scholar
  33. 33.
    Popovich J Jr, Sanders OJ Jr, Vij D, et al: Differential lung ventilation with a modified ventilator. Crit Care Med 9: 490–493, 1981.PubMedCrossRefGoogle Scholar
  34. 34.
    Powner DJ, Eross B, Grenvik A: Differential lung ventilation with PEEP in the treatment of unilateral pneumonia. Crit Care Med 5: 170–172, 1977.PubMedCrossRefGoogle Scholar
  35. 35.
    Powner DJ, Grenvik A: Ventilatory management of life-threatening bronchopleural fistulae: a summary. Crit Care Med 9: 54–58, 1981.PubMedCrossRefGoogle Scholar
  36. 36.
    Rafferty TD, Palma J, Motoyama EK, et al: Management of a bronchopleural fistula with differential lung ventilation and positive end expiratory pressure. Respir Care 80: 654–657. 1980.Google Scholar
  37. 37.
    Rigg JRA: Pulmonary atelectasis after anaesthesia: pathophysiology and management. Can AnaesthSoc J 28: 305–313, 1981.PubMedCrossRefGoogle Scholar
  38. 38.
    Rivara D, Bourgain JL, Rieuf P, et al: Differential ventilation in unilateral lung disease: effects on respiratory mechanics and gas exchange. Intensive Care Med 5: 189–191, 1979.PubMedCrossRefGoogle Scholar
  39. 39.
    Sykes MK, McNicol MW, Campbell EJM: Respiratory failure. Osney Mead, Oxford: Blackwell, 1976 pp 273 and 274.Google Scholar
  40. 40.
    Venus B, Pratap KS, Op’tholt T: Treatment of unilateral pulmonary insufficiency by selective administration of continuous positive airway pressure through a double-lumen tube. Anesthesiology 52: 74–77, 1980.CrossRefGoogle Scholar
  41. 41.
    Wood RE, Campbell D, Razzuk MA, et al: Surgical advantages of selective unilateral ventilation. Ann Thorac Surg 14: 173–180, 1972.PubMedCrossRefGoogle Scholar
  42. 42.
    Zack MB, Pontoppidan H, Kazemi H: The effect of lateral positions on gas exchange in pulmonary disease: a prospective evaluation. Am Rev Respir Dis 110: 49–55, 1974.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1982

Authors and Affiliations

  • Dwayne R. Westenskow
  • Nathan L. Pace

There are no affiliations available

Personalised recommendations