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2016 ; 19
(1
): 89-96
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Management of refractory hypoxemia
#MMPMID26750680
Mehta C
; Mehta Y
Ann Card Anaesth
2016[Jan]; 19
(1
): 89-96
PMID26750680
show ga
Mechanical ventilation remains the cornerstone in the management of severe acute
respiratory failure. Acute respiratory distress syndrome (ARDS) is the most
common cause of respiratory failure. It is associated with substantial mortality,
and unmanageable refractory hypoxemia remains the most feared clinical
possibility. If hypoxemia persists despite application of lung protective
ventilation, additional therapies including inhaled vasodilators, prone
positioning, recruitment maneuvers, high-frequency oscillatory ventilation,
neuromuscular blockade (NMB), and extracorporeal membrane oxygenation may be
needed. NMB and prone ventilation are modalities that have been clearly linked to
reduced mortality in ARDS. Rescue therapies pose a clinical challenge requiring a
precarious balance of risks and benefits, as well as, in-depth knowledge of
therapeutic limitations.