Differential lung ventilation during adult donor care.

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.