Successful treatment of a 26-year-old male with asymmetric
lung injury following a traffic accident is described. The patient was admitted with
head injuries, right lung
contusion, right
pneumothorax, and multiple
rib fractures (right 1-9). He developed a left pneumohemothorax and complete
atelectasis of the lower lobe of the left lung two days later. Conventional
mechanical ventilation with and without
positive end-expiratory pressure (PEEP), supplemented by repeated therapeutic bronchoscopy, failed to reexpand the left lung. After 16 days of
atelectasis, synchronized differential lung ventilation using a double lumen endobronchial tube connected to two
ventilators (Siemens 900C) was instituted. Measurement of the tidal volume and static compliance of each lung showed marked inequality and 9 cm H2O of PEEP was applied selectively to the left lung (zero PEEP to the right) in an attempt to equalize tidal volumes. Evident improvement in blood
gases and chest radiograph was obtained within 30 min but weaning back to a single lumen tube required 6 days, and was complicated by further episodes of
atelectasis. Complete pulmonary and neurological recovery was obtained, and a normal chest radiograph was documented 3 months later. Differential ventilation proved simple to use, and highly effective in the management of this combination of lung problems.