Differential lung ventilation may be required when one lung is injured or affected
more than the other lung following, for example, aspiration, crush injury, or selective
pneumonia, or if lung rupture results in formation of a bronchopleural fistula.
Unilateral lung failure causes increased ventilation-perfusion mismatching that
often leads to severe hypoxemia. Treatment may include careful attention to ventilator
parameters to avoid overdistention of the less-affected lung or lateral decubitus
positioning of the donor with the less-affected lung down (gravitationally
dependent position). Under extreme conditions, use of a specialized double-lumen
endotracheal tube and separate ventilators with individualized parameters for each
lung is required to provide adequate oxygenation and ventilation for organ preservation.
(Progress in Transplantation. 2010;20:262-268)