Navigating Hypoxemic Respiratory Failure in Critically Ill Cardiac Patients

Acute respiratory failure is a common reason for admission to cardiac intensive care units and the prevalence of respiratory failure in this cohort is increasing over time. Hypoxemia can occur due to a variety of mechanisms; the most common cause in the cardiac intensive care units remains cardiogenic pulmonary edema, but other etiologies, such as pneumonia and acute respiratory distress syndrome, are also common. This article provides an update on mechanisms of hypoxemia among patients with cardiac critical illness, heart lung interactions during spontaneous and positive pressure ventilation, optimization of sedation and ventilation for cardiac patients including novel ventilation strategies, and management of refractory hypoxemia among patients with cardiac critical illness.