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
- 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!)
Posted 06/08/17 12:23:53 PM by Iheanacho (Obi) Emeruwa
For further reading...
Posted 06/08/17 12:40:54 PM by Iheanacho (Obi) Emeruwa
Created by Christopher Kelly
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
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