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3 Biocybernetics and Biomedical Engineering

3 2003

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Independent lung ventilation as a protective strategy in unilateral lung disease in children

Luchetti M., Marraro G. A., Galassini E. M.

Biocybernetics and Biomedical Engineering

2003

Vol. 23, no. 2

77-87

Independent Lung Ventilation (ILV) may be viewed as a lung protective ventilation strategy, since it avoids the overinflation of the healthy lung and allows adequate ventilation of the diseased lung. The aim of this paper is to provide a review of ILV as a protective strategy for the treatment of pediatric respiratory failure due to unilateral lung disease. An analysis of the literature regarding ventilator-associated lung injury, pathophysiology of unilateral lung disease and the efficacy of independent lung ventilation in the pediatric population was carried out. After an overview of unilateral lung disease and initial experience with ILV, the following topical areas are addressed: technique of selective bronchial intubation, mechanical ventilation and ventilator setting, and speculations about the future. Unilateral lung diseases can be treated successfully using SILV. In addition, SILV allows to selectively instilling into the lung medications such as surfactant. Despite its attractive characteristics, ILV has some drawbacks that still limit its use. Investigation in under way trying to simplify the technique and make it more accessible.

Haemodynamic variations during independent lung ventilation in paediatrics

Marraro G. A., Luchetti M., Galassini E. M.

Biocybernetics and Biomedical Engineering

2003

Vol. 23, no. 2

67-76

Independent lung ventilation (ILV) has been suggested in order to reduce volutrauma and barotrauma in the treatment of lung pathology with unilateral prevalence. The application of different PEEP levels to each lung can allow an increase in gas exange and reduce haemodynamic variations connected with high transpulmonary pressure. Application of synchronized ILV with ZEEP or 5 cm H2O PEEP did not in itself cause haemodynamic changes any different from those that occur with intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV) with 5 cm H2O of positive end-espiratory pressure (PEEP). Maintaining 5 cm H2O of PEEP in the less affected lung and increasing progressively PEEP from 5 to 15 cm H2O in the more pathologic lung, central venous pressure (CVP), cardiac rate and mean arterial pressure (MAP) remained stable. The application of progressive PEEP levels in the less damaged lung while maintaining a stable value in the more damaged lung showed an increase in CVP and cardiac rate and reduction in MAP: Applying synchronised ILV (sILV) an improvement in PaO2 was noted compared to volume controlled ventilation with 10 cm H2O of PEEP. The improvement in PaO2 appears more evident when the "best" PEEP for each lung has been applied.

Feedback-controlled independent lung ventilation - model studies

Glapiński J., Darowski M., Marraro G. A., Luchetti M.

Biocybernetics and Biomedical Engineering

2003

Vol. 23, no. 3

55-62

A feedback-controlled unit for independent lungs ventilation has been developed and tested. This device can be used to ventilate both lungs separately using only one ventilator. Using this flow divider we can apply different PEEP pressures in each lung, and independetly achieve different tidal volumes.