title: Frequency of hypoxic events in patients on a mechanical ventilator.
abstract: BACKGROUND
  Mechanical ventilation is an important tool in the management of respiratory failure in the critically ill patient. Although mechanical ventilation can be a life-saving intervention, it is also known to carry several side-effects and risks. Adequate oxygenation is one of the primary goals of mechanical ventilation. However, while on mechanical ventilation, patients frequently experience hypoxic events resulting from various causes, which need to be properly evaluated and treated.
  
  
  METHODS
  Data were obtained by prospectively reviewing all intensive care admissions during the period from March 2009 to March 2010 at a 651-bed urban medical center. Patients who developed hypoxemia (oxygen saturation ≤88% and a PaO2≤60 torrs) while on mechanical ventilation were investigated for the cause of hypoxic event.
  
  
  RESULTS
  During the study period, 955 patients required mechanical ventilation from which 79 developed acute hypoxia. The causes of acute hypoxia in decreasing order of occurrences were pulmonary edema, atelectasis, pneumothorax, pneumonia, ARDS, endotracheal tube malfunction, airway bleeding, and pulmonary embolism.
  
  
  CONCLUSIONS
  Appropriate evaluation of all hypoxic events must begin at the bedside. A step-by-step approach must include a thorough physical examination. Evaluation of the endotracheal tube can immediately reveal dislodgement, bleeding, and secretions. Correlation of physical examination findings with those on chest radiograph is essential. Each hypoxic event requires a different intervention depending on its etiology. Instead of simply increasing the fraction of oxygen in the inspired air to overcome hypoxia, a concerted effort in appropriate problem solving can reduce the likelihood of an incorrect diagnosis and management response.
authors: Pulmonary Division, Department of Medicine, St. Joseph's Regional Medical Center, Paterson, New Jersey, USA ; Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey, USA.
authors: Nader A
authors: NA
authors: Mahmood
authors: Fawad A
authors: FA
authors: Chaudry
authors: Hamad
authors: H
authors: Azam
authors: M Imran
authors: MI
authors: Ali
authors: M Anees
authors: MA
authors: Khan
keywords: Hypoxemia; hypoxia; mechanical ventilation
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