Purpose of Review: 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. Recent Findings: 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. Summary: 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.
Clinical management of severely hypoxemic patients / N. Patroniti, S. Isgrò, A. Zanella. - In: CURRENT OPINION IN CRITICAL CARE. - ISSN 1070-5295. - 17:1(2011), pp. 50-56.
|Titolo:||Clinical management of severely hypoxemic patients|
ZANELLA, ALBERTO (Ultimo)
|Parole Chiave:||acute respiratory distress syndrome; extracorporeal membrane oxygenation; highfrequency oscillatory ventilation; prone positioning; severe hypoxemic respiratory failure; Anoxia; Extracorporeal Membrane Oxygenation; Humans; Positive-Pressure Respiration; Prone Position; Respiratory Distress Syndrome, Adult; Survival; Severity of Illness Index; Critical Care and Intensive Care Medicine|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||2011|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1097/MCC.0b013e3283427280|
|Appare nelle tipologie:||01 - Articolo su periodico|