Abstract

Conclusion We need a more individualised approach of hypoxic respiratory failure and ARDS. It is questionable that the new Berlin ARDS definition was the most required change to our approach of ARDS. One could argue that our patients could be better off, if we had moved away from trying to find commonality between very different conditions as the old and new ARDS definitions do. The ‘one size fits all’ approach tried for many years has not led to substantial progress. It may be high time for a different strategy and during the mean time, it may also be wise to use physiology as a compass to avoid the obvious mistakes associated with a cookbook approach.

Highlights

  • The pressure of arterial oxygen to fractional inspired oxygen concentration (PaO2/FIO2) ratio is a commonly used indicator of lung function in critically ill patients

  • We review here the main determinants of PaO2/FIO2 ratio and discuss how the application of a few physiological key concepts can be used to optimise the management of patients with hypoxic respiratory failure

  • It is questionable that the new Berlin acute respiratory distress syndrome (ARDS) definition was the most required change to our approach of ARDS

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Summary

Introduction

The pressure of arterial oxygen to fractional inspired oxygen concentration (PaO2/FIO2) ratio is a commonly used indicator of lung function in critically ill patients. Despite having the merit of simplicity and availability, the PaO2/FIO2 is more complex to interpret than being acknowledged and can at times be misleading. This risk is present if one does not understand or consider the key determinants of the PaO /FIO ratio in each individual patient and why this ratio may change over time. We review here the main determinants of PaO2/FIO2 ratio and discuss how the application of a few physiological key concepts can be used to optimise the management of patients with hypoxic respiratory failure.

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