title: Management of refractory hypoxemia.
abstract: 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.
authors.affiliation: Institute of Critical Care and Anaesthesiology, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Chitra
authors.initials: C
authors.lastname: Mehta
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D016684:Prone Position; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*