hypoxemic respiratory failure
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Introduction
Etiology
- acute respiratory distress syndrome (ARDS) is a syndrome of hypoxemic respiratory failure that presents as noncardiogenic pulmonary edema
- cardiogenic pulmonary edema
- pneumonia
Pathology
- V/Q mismatch, perfused areas of the lung are not ventilated
- inadequate oxygenation of hemoglobin
Management
- supplemental oxygen
- SaO2 <= 88 mm Hg at rest or with exercise
- high-flow oxygen delivered by nasal cannula for hypoxemic acute respiratory failure with lower mortality at 90 days, more ventilator- free days, & less respiratory discomfort than BiPAP[2][3]
- endotracheal intubation & mechanical ventilation rate similar for BiPAP vs high-flow oxygen[2]
- BiPap contraindicated with nausea, vomiting[1]
- hypoxia due to pulmonary shunts will not correct with supplemental oxygen (heart failure, ARDS)[1]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 2.0 2.1 2.2 Frat J-P et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015 Jun 4; 372:2185. PMID: https://pubmed.ncbi.nlm.nih.gov/25981908
Stephan F et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: A randomized clinical trial. JAMA 2015 Jun 16; 313:2331. PMID: https://pubmed.ncbi.nlm.nih.gov/25980660 - ↑ 3.0 3.1 Qaseem A et al. Appropriate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure: A clinical guideline from the American College of Physicians. Ann Intern Med 2021 Apr 27; [e-pub]. PMID: https://pubmed.ncbi.nlm.nih.gov/33900796 https://www.acpjournals.org/doi/10.7326/M20-7533
Baldomero AK et al. Effectiveness and harms of high-flow nasal oxygen for acute respiratory failure: An evidence report for a clinical guideline by the American College of Physicians. Ann Intern Med 2021 Apr 27; [e-pub]. PMID: https://pubmed.ncbi.nlm.nih.gov/33900793 https://www.acpjournals.org/doi/10.7326/M20-4675
Baldomero AK, et al Effectiveness and harms of high-flow nasal oxygen (HFNO) for acute respiratory failure: a systematic review protocol. BMJ Open. 2020. PMID: https://pubmed.ncbi.nlm.nih.gov/32051320 Free PMC article.