TY - JOUR T1 - Approaches to Refractory Hypoxemia in Acute Respiratory Distress Syndrome: Current Understanding, Evidence, and Debate JF - Respiratory Care SP - 1573 LP - 1582 DO - 10.4187/respcare.01366 VL - 56 IS - 10 AU - Stephen R Collins AU - Randal S Blank Y1 - 2011/10/01 UR - http://rc.rcjournal.com/content/56/10/1573.abstract N2 - Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) cause substantial morbidity and mortality despite our improved understanding of lung injury, advancements in the application of lung-protective ventilation, and strategies to prevent ventilator-induced lung injury. Severe refractory hypoxemia may develop in a subset of patients with severe ARDS. We review several approaches referred to as “rescue” therapies for severe hypoxemia, including lung-recruitment maneuvers, ventilation modes, prone positioning, inhaled vasodilator therapy, and the use of extracorporeal membrane oxygenation. Each shows evidence for improving oxygenation, though each has associated risks, and no single therapy has proven superior in the management of severe hypoxemia. Importantly, increased survival with these strategies has not been clearly established. ER -