Independent lung ventilation (ILV)

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Permalink Reply by Marwan A Alhazmi on June 27, 2009 at 6:01am

Great Topic...

I have seen and participated in the management of at least 3 or 4 cases of ILV during my 4 years experience at King Fahad National Guard Hospital.....


Success wise:

We used it for 2 disease pathologies; Severe Air leak Syndrome with multiple chest tubes and Pt's with lobectomy or unilateral lung surgery. Well, It was pretty successful in the management of Air leak syndrome (by isolating the lung pathology) only if one side is affected.
Basically, the theory behind using it with air leak syndrome that the fact pressure will always target the least resistant areas (the leaking areas) which further worsens the leak and compromise ventilation in the healthy lung. By using ILV, you can use only CPAP with the diseased lung or at least limit the pressure to a safe pressure and ventilate the healthy lung with a good Vt (given in consideration we are ventilating one lung, Vt/2)....

Surgical patients, mostly to isolate disease process that might follow surgery if there is any(pnumonia, infections) so you protect the healthy lung, plus providing safe low Vt/Pressure ventilation to the sensitive post surgery lung.

Outcome: If I remember right, the ILV strategy was successful in providing effective ventilation to these cases (in spite of not having a solid literature to support it's use) and provided improvement in their pulmonary status,but the general outcome was not positive as these patients had very advanced Dz's.

Again, the absence of a strong evidence will always make the use of ILV questionable, but I personally acknowledge this technique and believe in it's advantages.

PS: having two ventilators that are able to Synchronize is a must in order for this technique to work best I believe... eg: Dragger Evita XL... PB 840 I believe...(not sure about 840)

Thanx for the great topic

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Permalink Reply by SALEM M ALQAHTANI on June 27, 2009 at 10:55pm

Thank you Marwan,

Theoretically, it looks good approach however I don't know for sure why the outcome is disappointing.

I hope we will hear more from RT space members in order to come to better understanding of such technique.

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