Intensive Care Medicine

, Volume 44, Issue 9, pp 1528–1531 | Cite as

Adjunct and rescue therapies for refractory hypoxemia: prone position, inhaled nitric oxide, high frequency oscillation, extra corporeal life support

  • Niall D. Ferguson
  • Claude GuérinEmail author
What's New in Intensive Care
The mortality of severe acute respiratory distress syndrome (ARDS), defined with a PaO 2/FiO 2 ratio of 100 mmHg or less with at least 5 cm H 2O of PEEP, still exceeds 40% [ 1]. Furthermore, although it is true that more ARDS patients die from multi-organ failure than hypoxemia per se, an important subgroup of severe ARDS do die from refractory hypoxemia often defined as a PaO 2 < 60 mmHg despite FiO 2 1.0 [ 2]. Therefore, rescue treatments aiming at preventing hazardous hypoxemia are crucial. In this paper, we will cover prone position, inhaled nitric oxide (iNO), high-frequency oscillation (HFO) and extracorporeal life support (ECLS) as interventions to treat refractory hypoxemia. For each of them, we will discuss mechanism of action to improve hypoxemia (Fig.  1), potential benefits and risks, and make a personal recommendation about use. Before moving towards these measures, clinicians should ensure the basics are attended to—intravascular volume optimized, cardiac output sufficient [ 3],...


Compliance with ethical standards

Conflicts of interest

The authors declare no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology, and Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  2. 2.Division of Respirology, Department of MedicineUniversity Health Network and Mount Sinai HospitalTorontoCanada
  3. 3.Toronto General Research InstituteTorontoCanada
  4. 4.Réanimation médicale, Hôpital de la Croix Rousse, Hospices civils de LyonLyonFrance
  5. 5.Université de LyonLyonFrance
  6. 6.INSERM 955CréteilFrance

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