What treatment may be indicated for refractory hypoxemia?

Refractory hypoxemia refers to a condition where patients do not respond adequately to conventional oxygen therapy, leading to persistent low oxygen levels in the blood. One effective treatment option for managing refractory hypoxemia is the use of Positive Pressure Ventilation (PPV) combined with either Positive End-Expiratory Pressure (PEEP) or Continuous Positive Airway Pressure (CPAP).

This approach helps improve oxygenation by increasing lung volumes and recruiting collapsed or under-ventilated alveoli, thus enhancing gas exchange. By utilizing PEEP or CPAP, it increases functional residual capacity and reduces shunting, thereby promoting better oxygenation. Additionally, PPV can help to relieve respiratory distress by aiding in ventilation and reducing the work of breathing.

In contrast, continuous oxygen therapy and standard supplemental oxygen may not provide adequate assistance for patients experiencing refractory hypoxemia, as they primarily augment the inspired oxygen concentration but do not address potential issues related to lung mechanics or ventilation-perfusion mismatch. High-frequency oscillatory ventilation, while useful in specific scenarios such as ARDS, may not be the first-line treatment for refractory hypoxemia in many clinical situations.