Strategies to Manage Refractory Hypoxemia in the Intubated Patient

Persistent hypoxemia after intubation is associated with high mortality and demands a systematic approach focused on the underlying pathophysiology. This article emphasizes developing a focused differential diagnosis that includes both mechanical and patient factors to guide management. The authors review key therapeutic strategies, including careful use of positive end expiratory pressure, positioning techniques, medications such as inhaled pulmonary vasodilators, sedation, and neuromuscular blockade, and, when conventional therapies fail, consideration of extracorporeal membrane oxygenation.