Differential ventilation with selective PEEP in bilateral lung disease.

A patient with severe, acute respiratory failure (ARF) due to bilateral lung disease has been treated with a new ventilation concept aimed at improving the vertical match of ventilation and perfusion. The patient suffered from severe hypoxemia in spite of artificial ventilation with high PEEP and high inspired oxygen fraction. He was intubated with a double lumen bronchial catheter and placed in the lateral decubital posture, whereafter each lung was ventilated in accordance with its assumed perfusion, and selective PEEP of 10-15 cm H2O to the dependent and 0-5 cm H2O to the non-dependent lung was applied. Differential ventilation with selective PEEP resulted in a substantial improvement in pulmonary gas exchange in two separate periods of 3-4 days. The technique thus proved to be efficient and also clinically feasible in a standard intensive care unit.