Anaes Cases · Applied cardiovascular & respiratory physiology
Oxygen-refractory hypoxia after intubation
The hot case — the oxygen-refractory hypoxia is the shunt. The endobronchial intubation (the right main bronchus) is the common cause; the auscultation, the tube withdrawal, and the bilateral expansion confirm. Distinguish from the V/Q mismatch and the oesophageal intubation.
On this page
Study tools
Target exams
ANZCAFRCAABAEDAIC
Prompt
Immediately after the intubation for a rapid sequence, the saturation stays at 86 per cent despite the 100 per cent oxygen, with the high airway pressures. Diagnose and manage using the physiology.
Presentation
A rapid-sequence intubation for the small-bowel obstruction. Immediately after the intubation and the confirmation of the tracheal position by the capnography, the saturation falls to 86 per cent and fails to improve with the 100 per cent oxygen. The airway pressures are high (the peak of 38 cmH2O). The capnograph shows a good trace. Diagnose and manage.[42225458]
References3ShowHide
- [5]Nakamura S, et al. Intraoperative alveolar dead space fraction. J Cardiothorac Vasc Anesth, 2026.PMID 42225457
- [4]Nimmagadda U, et al. Preoxygenation: physiologic basis. Anesth Analg, 2017.PMID 28099321
- [42225458]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.