Refractory Hypoxemia – Changes in the Exudative Phase (Nursing)

by Prof. Lawes

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    00:01 Refractory means stubborn or unmanageable or resistant to a process or stimulus.

    00:07 That's what that word means inside and outside of medicine.

    00:11 Stubborn, unmanageable, resistant to process or stimulus.

    00:17 Now, we say stubborn, unmanageable resistant to processor stimulus, low oxygen in the blood.

    00:25 So, no matter how we try to ventilator oxygenate this patient, we just can't make it work that PaO2/FiO2 level is still too low.

    00:36 Take a look at that Berlin definition you see right there.

    00:39 Remember we talked about that in the beginning.

    00:41 We talked about the PaO2/FiO2 ratio.

    00:44 We've got the breakdown there for mild to moderate to severe.

    00:48 Now, which category do you think refractory hypoxemia would fall into? Right, severe.

    00:55 This is when we're in big trouble for our patient.

    00:58 So, that refractory hypoxemia is low levels of oxygen in the blood despite increasing the delivery of oxygen.

    01:06 It's rare, but very serious and a life-threatening complication of ARDS.

    01:12 So, is there anything we can do? Yes, there's some things I'll get to those in just a minute, but I want to make sure you are clear on what this definition is.

    01:22 So physiologically, it's been defined as an increase in partial pressure of oxygen in arterial blood.

    01:29 Yes, you already know that is PaO2.

    01:32 So, in looking at as a increase in the PaO2 of less than 5 millimeters.

    01:39 If the fraction of inspired oxygen the FiO2 is increased by 0.1 or 10 %.

    01:47 Okay, so what does that mean? Well, that means if I have a patient who is on 75% oxygen, right.

    01:55 So let's say you're on a ventilator, they're on 75% oxygen which is higher than I would want them to be look at that definition.

    02:05 So if we increase the oxygen by 0.1, then I would bump that patient up to 85%.

    02:12 But the PaO2 change I saw was less than 5.

    02:17 So, if my PaO2 before this ventilator change was set at 75 when I Increased it to 85% FiO2 and only bumped up to 77 that would be considered refractory hypoxemia.

    02:32 So for practical purposes, there's various criteria been applied most commonly is considered as one of these other things, right.

    02:40 Because that was a lot for me to talk you through.

    02:42 Look at these, it's either a PaO2 of less than 60.

    02:46 Hello, because remember normal is 80 to 100 or it's the defiinition you see here that we just talked about.

    02:55 PF of less than or equal to 100 on FiO2 of 80% to a 100% with peep positive end pressure of greater than 30 centimeters.

    03:09 Okay, this is wow.

    03:11 We're going to add on to that a plateau pressure of 30.

    03:14 Now, if your eyes just glazed over and you said, I don't even know what you are talking about.

    03:19 That is okay, all right.

    03:20 I just want you to know takeaway point from this.

    03:23 Refractory hypoxemia means we're doing some pretty fancy ventilator settings and oxygen support and we're not making that big a difference in the PaO2.

    03:34 So, easier than memorizing all this is just think been an easy one to go with is PaO2 less than or equal to 60.

    03:41 And refractory means no matter what we're trying, it doesn't seem to be making a difference in the PaO2.

    03:48 Why are we looking at that number? Because the PaO2 helps us quantify the lungs ability to get oxygen from the lungs into the blood stream.

    About the Lecture

    The lecture Refractory Hypoxemia – Changes in the Exudative Phase (Nursing) by Prof. Lawes is from the course Acute Respiratory Distress Syndrome (ARDS) (Nursing).

    Included Quiz Questions

    1. FiO2 increased 10% and PaO2 increased 2 mm Hg
    2. FiO2 increased 10% and PaO2 increased 8 mm Hg
    3. FiO2 increased 5% and PaO2 increased 5 mm Hg
    4. FiO2 increased 5% and PaO2 increased 4 mm Hg
    1. less than or equal to 60 mm Hg
    2. less than or equal to 80 mm Hg
    3. less than 50 mm Hg
    4. less than 40 mm Hg

    Author of lecture Refractory Hypoxemia – Changes in the Exudative Phase (Nursing)

     Prof. Lawes

    Prof. Lawes

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