Hospital procedure and nursing for patients treated with synchronised independent lung ventilation (sILV)

Abstract

Ward procedure, methodology and nursing are discussed in relation to the application of synchronised Independent Lung Ventilation (sILV), to patients with lung pathologies with unilateral prevalence, and when it is useful to apply a different Positive End Expiratory Pressure (PEEP), and/or a different ventilation to the two lungs independently. Nursing can be assisted, related problems can be much simplified and improvisation can be eliminated by rigorously applying treatment schedules worked out by the whole staff together. Synchronised ventilation is used because it is necessary to keep the mediastinum in situ during the respiratory act, so that the hemeo-static implications of mediastinal displacement can be avoided. Advantages from the correct application of sILV are: • -effective ventilation of the more pathological lung, with an increase of its residual functional capacity; • -reduction of hyperventilation and barotrauma in the less damaged lungs • -the possibility of using selective positive expiratory end-pressures (PEEP) in the two lungs in order to exploit therapeutic efficacy and to reduce hemodynamic failure; • -the possibility of using reduced concentrations of oxygen in the gases distributed in order to mitigate problems concerning its potential toxicity. With experience, the method, which seems complicated and difficult at first sight, becomes quite easy.