title: Ultra-protective ventilation and hypoxemia.
abstract: Partial extracorporeal CO2 removal allows a decreasing tidal volume without respiratory acidosis in patients with acute respiratory distress syndrome. This, however, may be associated with worsening hypoxemia, due to several mechanisms, such as gravitational and reabsorption atelectasis, due to a decrease in mean airway pressure and a critically low ventilation-perfusion ratio, respectively. In addition, an imbalance between alveolar and artificial lung partial pressures of nitrogen may accelerate the process. Finally, the decrease in the respiratory quotient, leading to unrecognized alveolar hypoxia and monotonous low plateau pressures preventing critical opening, may contribute to hypoxemia.
authors.affiliation: Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August-University of Göttingen, Göttingen, Germany. gattinoniluciano@gmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D006801:Humans; D001261:Pulmonary Atelectasis / Q000150:complications / Q000503:physiopathology; D012121:Respiration, Artificial / Q000379:methods / Q000592:standards*; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000209:etiology*; D013990:Tidal Volume / Q000502:physiology; D014692:Ventilation-Perfusion Ratio / Q000502:physiology