Synchronized independent lung ventilation in palliated XXXX with variable sources of pulmonary blood flow.

@entity1 @entity473 @entity215 @entity519 @entity358 @entity842 @entity1576 @entity299
OBJECTIVE: Presentation of two @entity1 studies demonstrating the use of synchronized independent lung ventilation in the management of acute @entity1576 in @entity1 with @entity299 and variable sources of pulmonary blood flow. DESIGN: Clinical course of two @entity1 . SETTING: Cardiac intensive care unit in a tertiary care, university-affiliated pediatric teaching hospital. @entity1 : @entity1 1 was a 22-yr-old @entity1 with a single ventricle and right lung blood flow supplied by a classic Glenn shunt and left lung blood flow through a systemic-to-pulmonary artery shunt. @entity1 2 was a 12-yr-old @entity1 with @entity215 and complete common @entity473 with right lung blood flow supplied by a classic Glenn shunt and left lung blood flow supplied by the right ventricle. Both @entity1 presented with acute, left-sided @entity358 and @entity519 . INTERVENTIONS: We used selective bronchial intubation via a double-lumen tracheal tube with a bronchial extension for synchronized independent lung ventilation to permit high-pressure ventilation of the abnormal left lung low-pressure ventilation of the normal right lung supplied by a Glenn shunt. Inhaled @entity842 was administered to both @entity1 and continued in one when improved oxygenation was observed. MEASUREMENTS AND MAIN RESULTS: Serial arterial blood gas measurements, mechanical indices of pulmonary function, and chest radiographs were closely followed. Synchronized independent lung ventilation contributed to improvements in systemic arterial blood oxygenation and alveolar ventilation allowing resumption of conventional ventilation in both @entity1 . No adverse effects related to bronchial tube placement or maintenance occurred. CONCLUSION: Independent lung ventilation is an effective means of isolating the two lungs for differential ventilation, as well as the selective delivery of inhaled medications. In @entity1 with @entity358 and a Glenn shunt supplying the unaffected lung, selective lung ventilation allows aggressive treatment of the abnormal lung while optimizing flow through the Glenn shunt to maximize effective pulmonary blood flow, systemic oxygenation, and hemodynamics.
