It is extremely rare, end obronchial blocker or ILV (independent lung ventilation) with separate ventilation have been used in unilateral lung via a DLT (double lumen end otracheal tube). End bronchial blocker is an alternate choice, especially in the presence of unilateral lung abscess or active bleeding, not only can use the end obronchial tube and double-lumen end otracheal tube to prevent the expansion of the lesion and normal lungs can also be further use of ILV mode to improve oxygenation to avoid breathing apparatus caused by VILI (ventilator-induced lung injury) but increased airway resistance by reducing FRC (functional residual capacity) and obstructed with secretions that may be limited its usefulness. We described a case of a single unilateral pulmonary abscess with acute respiratory distress syndrome in female patients, the use of traditional respirator mode still can’t improve the oxygenation, the successful use of ILV model to improve oxygenation and the implementation of lung protection ventilation, and discuss the actual clinical application of ILV related issues.