• Crit Care · May 2016

    Ultra-protective ventilation and hypoxemia.

    • Luciano Gattinoni.
    • Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August-University of Göttingen, Göttingen, Germany. gattinoniluciano@gmail.com.
    • Crit Care. 2016 May 12; 20 (1): 130.

    AbstractPartial 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.

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