• Initial options for managing hypoxemia
  • Nasal cannula, non-rebreather
    • Can't exactly quantify FiO2 on NRB, but if someone if hypoxemic on NRB, they have an elevated A-a gradient!
  • High-flow nasal cannula
    • Doesn't prevent intubation any better than non-invasive positive pressure ventilation (NIPPV), but has mortality benefit
  • NIPPV
    • Not generally indicated for hypoxemic respiratory failure, but useful in cardiogenic pulmonary edema
    • Make sure patient has a mental status, as it offers no airway protection and can actually provoke emesis by insufflating stomach
  • Mechanical ventilation
  
  What to do when people remain hypoxemic on mechanical ventilation?
  • Can use inhaled NO, but no mortality benefit, only improvement in oxygenation
  • In general, should escalate through strategies in the following order:
    • Low tidal volume ventilation (low PEEP v high PEEP strategies)
    • Paralysis (make sure patients are heavily sedated, i.e. RASS -5!)
    • Proning
    • ECMO
  
  

  Posted 06/08/17 12:23:53 PM by Iheanacho (Obi) Emeruwa

• For further reading...

  High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure
  Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome
  Prone Positioning in Severe Acute Respiratory Distress Syndrome
  
  

  Posted 06/08/17 12:40:54 PM by Iheanacho (Obi) Emeruwa

Created by Christopher Kelly

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