CLINICAL MANAGEMENT OF LIFE-THREATENING HYPOXEMIA

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OBJECTIVES

Review core concepts in pulmonary physiology.

Define ventilation/perfusion (V/Q) mismatch).

Define intrapulmonary shunt.

Discuss differences between treatment of V/Q mismatch and intrapulmonary shunt.

Calculate a PaO2/FIO2 ratio and explain its clinical significance.

Define mean airway pressure.

List three ventilator settings that will result in an increase in mean airway pressure.

Discuss the relationship between intrapulmonary shunt, low cardiac output, low SvO2/ScvO2 and arterial hypoxemia.

Explain how arterial pressure waveforms can be used to assess preload responsiveness.

Explain the potentially negative impact of plateau pressure, PEEP, and PaCO2 on right ventricular function in the mechanically ventilated patient.

Discuss recent research findings indicating a survival benefit of prone positioning in the most severely hypoxemic ARDS patients.

Discuss the physiologic benefits of extracorporeal membrane oxygenation.

Explore the significance of a decrease in systolic blood pressure associated with a change in ventilator settings.

Explain how auto-PEEP can cause right ventricular dysfunction in the ventilated patient.

 

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