Hypoxemia - NYSORA

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Hypoxemia

Learning objectives

  • Recognize hypoxemia 
  • Differential diagnosis of hypoxemia
  • Management of hypoxemia

Definition and mechanism

  • A decrease in the partial pressure of oxygen in the blood
  • Severe when oxygen saturation falls below 90%
  • Acute hypoxemia will eventually cause circulatory arrest due to myocardial hypoxia with:
    • Irreversible cardiac damage
    • Loss of consciousness within 10 seconds
    • Irreversible brain damage within 4-5 minutes

Signs and symptoms

  • Shortness of breath
  • Increased breathing rate
  • Headache
  • Coughing
  • Tachycardia
  • Use of chest and abdominal muscles to breath
  • Cyanosis
  • Hemoptysis

Diagnosis

  • Pulse oximetry
  • Arterial blood gas test
  • Six-minute walk test

Differential diagnosis

Equipment failure
HypoventilationLow TV or RR
Ventilator dyssynchrony
Circuit leak
Obstructed ETT
Ventilation-perfusion mismatch
Bronchospasm
Mainstem intubation
Pulmonary edema
Aspiration
Atelectasis
Pneumothorax
Pleural effusion
Right-to-left shuntIntracardiac shunting
Diffusion impairmentPulmonary edema
Pneumonia
Low PO2Increased dead space
Pulmonary embolism
Reduced cardiac output
Increased metabolic O2 demand
Malignant hyperthermia
Sepsis
Neuroleptic malignant syndrome

Management

Hypoxemia, 100% O2, ETo2, oxygen, FiO2, PEEP, bronchodilators, ETT, X-ray, peak inspiratory pressure, ETCO2, ECG

Suggested reading

  • Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
  • Rozé H, Lafargue M, Ouattara A. Case scenario: Management of intraoperative hypoxemia during one-lung ventilation. Anesthesiology. 2011;114(1):167-174.

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