Page 414 - Clinical Application of Mechanical Ventilation

380 Chapter 12

STRATEGIES TO IMPROVE OXYGENATION

Oxygenation is dependent on adequate and well-balanced ventilation, diffusion,
oxygenation: Amount of oxygen
available for metabolic functions; and perfusion. The strategies to improve oxygenation are therefore structured to
affected by ventilation, diffusion improve the normal physiologic functions or to compensate for the abnormal ones.
and perfusion.
The prioritized methods to improve oxygenation, from simple to complex, are
outlined in Table 12-3.

Increase Inspired Oxygen Fraction (F O )
I
2
Supplemental oxygen is most frequently used to manage hypoxemia because a high
Oxygen readily corrects F O increases the alveolar-capillary oxygen pressure gradient, thus enhancing dif-
hypoxemia that is due to I 2
uncomplicated V/Q mismatch. fusion of oxygen from the lungs to the pulmonary circulation. Oxygen readily
corrects hypoxemia that is due to uncomplicated V/Q mismatch.

TABLE 12-3 Strategies to Improve Oxygenation

Priority Methods

1 Increase inspired oxygen fraction (F O )
I
2
2 Improve ventilation and reduce mechanical deadspace
3 Improve circulation
Fluid replacement if patient is hypovolemic
Vasopressors if patient is in shock
Cardiac drugs if patient is in congestive heart failure
4 Maintain normal hemoglobin level

5 Initiate continuous positive airway pressure (CPAP) only with adequate
spontaneous ventilation

6 Consider airway pressure release ventilation (APRV)

7 Initiate positive end-expiratory pressure (PEEP)
Titrate optimal PEEP (See Chapter 15 for titration of optimal PEEP using
decremental recruitment maneuver)

8 Consider inverse ratio ventilation
9 Consider prone positioning

10 Consider extracorporeal membrane oxygenation (ECMO), high frequency
ventilation, hyperbaric oxygenation
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