ResusX:Podcast Refractory Hypoxemia
Mar 12, 2025
Join critical care expert Nick Ghionne, also known as @PulmToilet, as he delves into the complex management of refractory hypoxemia. He shares transformative strategies for optimizing ventilator settings, emphasizing the importance of driving pressure and the effective use of PEEP. Nick highlights the life-saving role of proning in ARDS and discusses the nuanced application of adjunct therapies like nitric oxide. Tune in for practical tips that can enhance patient outcomes in critical care!
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Initial Assessment for Refractory Hypoxemia
- First, assess patient participation on the ventilator.
- Sedate or briefly paralyze to get accurate measurements if needed.
Understanding Driving Pressure
- Driving pressure (plateau pressure minus PEEP) helps assess lung compliance.
- Aim for a driving pressure less than 15 for better outcomes in ARDS.
PEEP Titration Strategy
- Increase PEEP if driving pressure decreases, indicating lung recruitment.
- Continuously monitor pressures at the bedside, especially in severe ARDS.