Independent lung ventilation in the postoperative management of single lung transplantation: case report

Independent lung ventilation (ILV) is a ventilation strategy used in patients with significant differences in respiratory mechanics between the 2 lungs owing to asymmetric or unilateral lung diseases. We report the case of a 66-year-old patient treated with ILV for a primary graft dysfunction occurred early after single lung transplantation. On intensive care unit admission, the patient was ventilated with pressure-controlled mechanical ventilation. Despite efforts to optimize ventilation and medical therapy, his clinical condition progressively worsened, manifesting hypoxemia, hypercapnia, and radiologic evidence of hyperinflation of the native lung, collapse of the graft, and mediastinal shift. The ventilation was therefore switched to ILV. A constant improvement in clinical conditions, arterial blood gas parameters, and radiologic findings was then obtained. The patients was weaned from mechanical ventilation and finally successfully extubated.