title: Clinical management of severely hypoxemic patients.
abstract: OBJECTIVE
  To describe a physiopathological-based approach to clinical management of severely hypoxemic patients that integrates the most recent findings on the use of rescue therapies.
  
  
  RESULTS
  Several techniques are available to improve oxygenation in severely hypoxemic patients. Survival benefits have not been proved for most of these techniques. In a recent randomized trial, centralization of acute respiratory distress syndrome patients to a specialized center able to provide extracorporeal membrane oxygenation showed better survival as compared to conventional treatment. Randomized trials failed to prove survival benefits with the use of high levels of positive end-expiratory pressure (PEEP) or prone positioning. However, pooled data from two meta-analyses showed significant higher survival in the most severe patients both with the use of higher PEEP and prone positioning.
  
  
  CONCLUSIONS
  Treatment of severely hypoxemic patients should aim to improve oxygenation while limiting ventilator-induced lung injury. A physiopathological approach that accounts for the underlying mechanisms of hypoxemia, and physiological and clinical effects of different treatments is likely the best guide we have to treat severely hypoxemic patients.
authors.affiliation: Department of Experimental Medicine, University of Milano-Bicocca, Ospedale San Gerardo Nuovo dei Tintori, Milan, Italy. nicolo.patroniti@unimib.it
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.forename: Stefano
authors.initials: S
authors.lastname: Isgrò
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanella
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011175:Positive-Pressure Respiration; D016684:Prone Position / Q000502:physiology; D012128:Respiratory Distress Syndrome; D012720:Severity of Illness Index; D013534:Survival