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01.12.2016 | Commentary | Ausgabe 1/2016 Open Access

Critical Care 1/2016

Ultra-protective ventilation and hypoxemia

Critical Care > Ausgabe 1/2016
Luciano Gattinoni
Wichtige Hinweise
This comment refers to the article available at: http://​dx.​doi.​org/​10.​1186/​s13054-016-1211-y.

Competing interests

The author declares that he has no competing interests.


Partial extracorporeal CO2 removal allows a decreasing tidal volume without respiratory acidosis in patients with acute respiratory distress syndrome. This, however, may be associated with worsening hypoxemia, due to several mechanisms, such as gravitational and reabsorption atelectasis, due to a decrease in mean airway pressure and a critically low ventilation-perfusion ratio, respectively. In addition, an imbalance between alveolar and artificial lung partial pressures of nitrogen may accelerate the process. Finally, the decrease in the respiratory quotient, leading to unrecognized alveolar hypoxia and monotonous low plateau pressures preventing critical opening, may contribute to hypoxemia.
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