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A technique for differential lung ventilation via a Carlens tube with inspiratory retardation and the application of separate levels of PEEP to each lung are described in the treatment of a patient with severe unilateral pneumonia. In addition to isolating the diseased lung, this technique permits modification of the distribution of ventilation between the two lungs to improve the ventilation-perfusion ratio and enhance arterial oxygenation. Its clinical application is influenced by the flow characteristics of available mechanical ventilators and by the limitations of the currently available double-lumen endobronchial tubes.

Indications for the use of therapy with continuous positive airway pressure (CPAP) in spontaneously breathing patients are increasing in number. The value of this technique without tracheal intubation was investigated in 14 patients with acute respiratory distress. In most patients (eight patients, or 57 percent) the technique was successful, as evidenced by avoidance of the necessity for tracheal intubation and improvements in clinical appearance, arterial oxygen pressure, and chest x-ray films. Complications were observed in three patients, but these necessitated discontinuation of therapy in only one. The use of this technique allows avoidance of endotracheal intubation and mechanical ventilation, with their attendant risks.