The clinical application of synchronized independent lung ventilation (S.I.L.V.) in pulmonary disease with unilateral prevalence in pediatrics

The authors report on their results in the clinical use of S.I.L.V. using two synchronized Siemens 900 C Servo Ventilators. The Mallincrodt Broncho-Cath 28 and 35 Fr was used for the independent bronchial intubation of children over five; while for children under three, we used both two separate cuffless tubes of suitable length, and the double lumen tube of our own manufacture (the Marraro bilumen tube). The new method was applied to 13 children aged between 4 hours and 11 years. Duration of S.I.L.V. was between 8 hours and 5 days. The advantages of S.I.L.V. compared to C.V. were increases of F.R.C. and of effective ventilation in the more damaged lung, with a reduction of hyperventilation and consequent barotrauma in the less damaged lung. It was also possible to apply different levels of PEEP in the two lungs, and to reduce the concentration of oxygen in the gases ventilated. In all the patients treated, the application of the new method provided rapid clinical, blood-gas analytical, and radiological improvement. The children electively treated all survived.