Refractory Hypoxemia Definition, Symptoms, Causes, Treatment

Refractory hypoxemia is a complicated therapeutic problem that frequently occurs during acute respiratory distress syndrome (ARDS). Patients who are being treated for acute respiratory failure with mechanical ventilation frequently experience the problem of refractory hypoxemia. Patients diagnosed with ARDS have a 20% to 30% chance of developing severe hypoxemia, which frequently results in high fatality rates. In patients with ARDS, refractory hypoxemia is the cause of death in approximately 10% to 15% of cases.

ARDS is the leading cause of admission to critical care units (ICUs), accounting for around 10% of all such cases. To further comprehend hypoxemia, it is necessary to examine its systemic effects in greater detail. When refractory hypoxemia sets in, the alveoli either become saturated or collapse completely.

Because of the excessive debris or fluid, the alveolar-capillary barrier will not allow inspired gas to pass through it. As a consequence of this, the lungs continue to have difficulty functioning optimally despite the increase in the amount of oxygen that is inspired. As a result, deoxygenated blood continuously mixes, which causes arterial hypoxemia.

Refractory Hypoxemia Definition

Refractory hypoxemia is a serious breathing problem that can occur in individuals who are being treated with mechanical ventilation and who have acute respiratory failure. It is characterized by insufficient arterial oxygenation despite the adequate oxygen supply.

Refractory Hypoxemia Symptoms

The majority of the symptoms are almost identical to those seen in general hypoxemia episodes.

• Cyanosis is caused when tissues do not receive the sufficient amounts of oxygen that they require.
• A racing or quickening of the heart. In cases of hypoxemia, this condition develops when the normal circulation of blood fails to supply the body with enough amount of oxygen, which forces the heart to work harder than it normally does.
• The shortage of oxygen in the arterial circulation, which is harming the lungs, might cause increased shortness of breath.
• Tiredness, confusion, and not being able to move well.
• Pain in the head and lightheadedness.

Refractory Hypoxemia Causes

The most frequent cause of refractory hypoxemia in individuals with severe respiratory failure is acute respiratory distress syndrome (ARDS). In spite of the fact that many of the recommended therapeutic options for this illness can enhance oxygenation without any actual survival improvements, uncontrollable refractory hypoxemia remains the most worrisome situation faced by critical care physicians.

Other clinical complications that can result in refractory hypoxemia include infections, pneumonitis, significant trauma, pulmonary aspiration and choking, burns, overdoses, and radiation exposure. ARDS-related severe acute lung damage is by far the most frequent cause of hypoxemia that is refractory to treatment.

Refractory Hypoxemia Treatment

Hypoxemia that is refractory to treatment caused by acute respiratory distress syndrome (ARDS) is linked to a high death rate. Conservative treatments like mechanical ventilation or supplemental oxygenation do not address the root cause of the issue, and the mortality risk remains extremely high. Extracorporeal membrane oxygenation (ECMO) is a proven method for treating refractory hypoxemia in ARDS patients, but it is generally not advised when systemic infections are present.