• Hypoxemia is ubiquitous in the intensive care unit.
• Causes include hyperventilation, true shunt, diffusion impairment, ventilation-perfusion mismatch, decreased mixed venous oxygenation, and changes in the affinity of hemoglobin for oxygen binding.
• Diffusion impairment is not typically a significant cause of hypoxemia in the intensive care unit.
• Administration of pure oxygen does not correct hypoxemia due to pure shunt, whereas it does correct hypoxemia due to ventilation-perfusion mismatch.
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