One-lung ventilation is typically reserved for the operating room, and emergency use of the practice has not been widely explored.
But a new case study outlines the benefits of using one-lung ventilation with a double-lumen tube on the critically ill in the intensive care unit.
One-lung ventilation with a double-lumen tube may offer a safer alternative to extracorporeal membrane oxygenation (ECMO) for high-risk patients, according to the study. It’s less invasive and therefore helps prevent infection, the researchers conclude.
“Independent lung ventilation with use of a double-lumen endotracheal tube for refractory hypoxemia and shock complicating severe unilateral pneumonia: A case report,” was published in Respiratory Medicine Case Reports in May 2020.
In this study, a 90-year-old patient had severe unilateral pneumonia. He was unconscious when he arrived at the hospital.
Due to the patient’s age, physicians decided to forego ECMO because of possible complications from bleeding and the chances of infection from that method of ventilation.
ECMO involves pumping blood outside the body to the exchange of carbon dioxide for oxygen, allowing the lungs to rest and heal. By contrast, one-lung ventilation facilitates breathing through one lung while collapsing the other.
The doctors also note that ECMO is not available in every hospital. One-lung ventilation with a double-lumen tube could be an alternative in those settings.
Physicians in this case study used a double-lumen tube and two ventilators for four days on the patient. A single-lumen tube proved inadequate initially, because the pathophysiology of the left and right lungs varied so greatly, according to the study.
Using two ventilators on two different positive endo-expiratory pressure (PEEP) settings helped improve oxygenation and blood flow for the patient. The different PEEP settings for each lung helped prevent hyperinflation of the non-affected lung.
After four days, the physicians were able to switch to a single-lumen tube. The patient moved to a rehabilitation center, breathing on his own, within a week.
“Independent lung ventilation performed with use of a DLT is less invasive and more useful than extracorporeal membrane oxygenation,” the authors write. “Thus, independent lung ventilation should be kept in mind as a treatment option, especially in cases of refractory respiratory failure and circulatory failure in which the pathophysiology of the left and right lungs differs markedly.”
The authors also noted inherent complications with one-lung ventilation. These include proper tube selection, cuff pressure, intubation procedure, and proper patient positioning. For this reason, one-lung ventilation is rarely used for patients with severe unilateral pneumonia.
However, in this case, the ventilation system proved more useful than ECMO on a high-risk patient in the ICU, according to the researchers.