Management of Hypoxemia

Hypoxemia can occur at any time during lung transplantation, but is most common during one-lung ventilation. Hypoxemia is most severe about 20 min after initiation of one-lung ventilation, and initial treatment should include judicious use of positive end-expiratory pressure (PEEP) to the ventilated lung, oxygen insufflation to the non-ventilated lung, and clamping of the pulmonary artery of the nonventilated lung. Pneumothorax on the ventilated side should always be considered. If hypoxia is refractory to all interventions, cardiopulmonary bypass should be initiated.

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