[Management of unilateral or asymmetrical lung disease (author's transl)]

To determine the indications of body position, continuous positive airway pressure and independent lung ventilation in unilateral lung disease, we turned 10 patients with overwhelming unilateral lung disease from supine to lateral position. All patients were breathing spontaneously with a mask, then associated with continuous airway pressure (10 cm H2O PEEP) in five cases. During these spontaneous ventilation methods, hemodynamic parameters did not change, but arterial blood oxygen tension increased and intra-pulmonary shunting decreased significantly. Final recovery was obtained in 7 cases. In the 3 others, mechanical ventilation was needed because spontaneous breathing methods were ineffective in improving blood gases. Lateral position and conventional ventilation with positive airway pressure were also ineffective. Only independent ventilation enhanced arterial blood oxygen tension. But only one patient survived. We conclude that spontaneous breathing methods are able to provide successful treatment in most of patients with unilateral lung disease. In other patients, only independent lung ventilation is effective.